Laserfiche WebLink
C�?�% CYIat�Q <br /> Burnett County Office of Zoning Administr for fv ;F c <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3• ,0j <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and °� (J'( <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the i <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wisconsin. <br /> . .. . .Thvm. ... �r✓............................. .....N.oaT.h.�r� t..... QC D�.. ............ ...... <br /> OWNER IPIe V <br /> rind CONTRACTOR or SURVEYOR or AGENT 7 <br /> /..5.> .......�'.T.�j.... A..' .7............................... .....1�.7"../.............. . ........ ...................................... ...... s <br /> ADDRESS f/ ADDRESS <br /> . V v <br /> ........./WAV..........s`�.�`. i.............. ..... ..... <br /> .......1 .1....... U.... ...... <br /> ADDRESS G3 q / ADDR,�CEJSSL SC, <br /> PHONE2./... ... A4 .. f•.16.0........................ .PHONE./v.. ............�l..l... ..... o.HY..<.................. . <br /> a±�...........s ..-. sgy.. ................... . . ......... . .. .................................................................. ...... <br /> PLUMB R WELL DRILLER <br /> ........................................................................................... .A..DDR. 6'R" ......................................................................... ...... .O <br /> ADDRESS ESS.. m •0 <br /> ........................................................................................... . .......................................... ................................ ...... –. < <br /> PHONE PHON........E Z <br /> DESCRIPTION 4. SanitaryFacilities: ° o <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details •• c <br /> New Building Type No. Bedrooms <br /> •••• <br /> .......... Construction: R <br /> Addition ... ` Septic Tank Size Gals. <br /> ...... ...... ........ . .................. <br /> Sanitary .......... ftx �.. ft. ,f4 .........•..•.... ...... <br /> ............ <br /> i'• .:a ir(q` <br /> ` <br /> re <br /> •• . . .�Filling/Grading Heightstay' Absorption Field Site: <br /> ,..,.,..., U �e <br /> Moving .......... Area .......1..6 ........ ................ Soil Type .................. � <br /> i <br /> o <br /> Mobile Home <br /> Slope .......................................... <br /> 71 <br /> a� .. Perc. Rate ................................... N i <br /> Privy .......... 3. Use (describe exactly, 1 -family � <br /> Well home,garage,motel, etc.) Dry Well .......... m \ <br /> Subdivision L.V. 1,11. �7Gsr.1..T........ Seepage Trench z <br /> .. .... .. <br /> ........ . <br /> g Priv .. ....... <br /> Camping Unit .......... .................................................... y <br /> Seepage Bed .. ....... <br /> -------- <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fi . A. : C <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. I o <br /> [ <br /> _____________________________ __ J <br /> 5. Lot Size: Fig. A. 6. Location: _ <br /> ................ ft. x .............. ft ............ .................. sq.ft. ............................. ...... ............... ...... y . <br /> 0 <br /> P -- <br /> ZU <br /> 711 ° <br /> C / M <br /> Z <br /> o <br /> tia " <br /> Tj <br /> 3o bed�cz-m m c M 1. r > cm W -0 <br /> �/ = Nam -. am o. ny <br /> �l � d'S <br /> >u <br /> C <br /> oho : .z > - <br /> 1 <br /> Sew I ` o o M <br /> ` O <br /> 4��Xnelo_r__g_en <br /> . ........ . : ......... ot Date o <br /> Remarks .....V.. G✓i�ZFuw.. <br /> . ............... ...... ... ...... .._... <br /> .......................... _ — <br /> .�./K .......SLS/.1 ..../••.•r'5..............r.......1...�.Qlh +t5 dN <br /> .. ✓CLU.... .6.............r.......................... <br /> Inspection Date ....................................... .. <br /> m <br /> n............ ..... ..... ... ... m <br /> Zoning Ad Iistrator <br /> o g g y <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary fac ilities before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this appli ation 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 beer issued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or pecifications shall not be <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APF ROVED. <br />