Laserfiche WebLink
,�7? <br /> Bur:lett County Office of Zoning Administra or �' o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT3• 111.1 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described nd q M <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of he <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws nd 3 3 <br /> regulations of the State of Wisconsin. — a <br /> u..fil..... ......................... .. .... . .... ................... .. <br /> OWNER <br /> (please <br /> �7print) CONTRACTOR or SURVEY R or AGENT .�. <br /> .. . l <br /> . . .... .1..J.. .............................................................1/✓E LL �Qr Lt fig �� <br /> ...................................................................................... ..... d l :�i_y <br /> ADDRESS ADDRESS <br /> S..!%Ut?:G .. ...t�1N........5 ;�. . ................. ..........................`' ..`.:.............. ...................... ..... J <br /> ADDRESS f ADDRESS i of <br /> C1Z� �i4 - SS4.. ................................ .... J vo fi <br /> PHONE PHONE :1 i <br /> .. . ...... ............................................................................... ...WEL.....L.... <br /> D. . . <br /> RILL.ER............................................................... ...... :O <br /> PLUMBER ,s <br /> ......................... .... . ............................................................................... ...... <br /> .............................................................. _. <br /> ADDRESS AD.....DRESS C <br /> d < <br /> o <br /> ........................................................................................... ..................................................................................... ...... .: <br /> PHONE PHONE Z 2 r <br /> DESCRIPTION 4. Sanitary Facilities: 8 <br /> 1. Work: 2. New Building Details No. Bathrooms ... c <br /> New Building Type,pf Construction: No. Bedrooms <br /> Addition ...„•„ ^r G n Septic Tank Size Gals. <br /> Sanitary Size ....K.Vz <br /> ... ft. x ..3.G.... ft. ... ...... <br /> .'�."' <br /> Filling/Grading ,......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area ........................................... Soil Type ............................. ...... r <br /> Mobile Home Slope ................................... ...... .. <br /> .......... <br /> Privy .......... 3. Use (describe exact) C1 -fami Perc. Rate ............................ ...... 0 <br /> Well .......... home,garage, motel,etc.) Dry Well ... ...... a E <br /> Subdivision .................................................... Seepage Trench ... ...... o �- <br /> .......... <br /> CampingUnit Privy ... <br /> .......... ..................................... k........ C <br /> St ';z S d v " Seepage Bed / . X.r1. `lam :(^ <br /> __________________________________________ ___________________ <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fi . A. :A <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is local d at :� <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersect on. <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. :� o <br /> _________________________________________________________ __ <br /> 5. Lot Size: Fig. A. 6. Location: I7r�� <br /> ................ ft. x .............. ft. — ............................... sq.ft. : •r ' I <br /> ....................................................................... ....... ..Ql <br /> (1 0 <br /> N O <br /> O 57 <br /> e <br /> O <br /> i Y0 <br /> plat <br /> pi <br /> %I i <br /> 4A <br /> 2c . N N o c c <br /> I ov < o oo -. -. m <br /> r <br /> 0o •< N pm .a <br /> o c m <br /> S ' c <br /> nG <br /> ' 1 ........... .. x A <br /> $,gnature of caner or Agent Date $ <br /> T ' N <br /> Remarks <br /> ............................................... .................................................................... <br /> .............................................................. ..... <br /> o : g <br /> ........................................................................................................... ...... ................. ... .... W $ <br /> J'' T <br /> Inspection Date ....................................... ................................................. <br /> l <br /> ......... ..... .... ............. ............................ .... C1” <br /> Zoning Ad nistrator <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary IS ilities before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this app(cation before a permit will <br /> be issued. Do not purchase or install a septic tank, do any plumbing or start any building until a permit has bee 1 issued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or specifications shall not be <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND AP ROVED. <br />