Laserfiche WebLink
J <br /> Burnett County Office of Zoning Administrator M 0 o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3_ <br /> 0 <br /> TO THE ZONING ADMINISTRATOR, The undersigned hereby makes application for a Permit for the work described and located as < N <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use A m :L\ <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 0_ <br /> OWNER (please print) <br /> o <br /> MIke Egeland ............ <br /> ........................................................................ <br /> oi <br /> CONTRACTOR <br /> or SURVEYOR or AGENT Cu <br /> ..........291.$...36.th..Ave—N._E............ <br /> ADDRESS ADDRESSft, XD 'µ <br /> Minneapolis .( <br /> c"kan <br /> ADDRESS ADDRESS '� it=7 <br /> .............1.5-.1 2383..................................................... . .......................................................................................... � � `r° <br /> PHONE PHONE :-l� :9) <br /> .................................................................... ;a <br /> ..........Donald..Aaraiels................................................ t; <br /> PLUMBER WELL DRILLER <br /> BOX N <br /> A...D..D...R..E..S.S. . . <br /> ............................................................ . ................. <br /> ADDRESS. ........... .. am o <br /> ..........siren,...Wi.....5487.2.......... 63-23.33................ . .......................................................................................... o <br /> PHONE PHONE Zr <br /> DESCRIPTION 4. Sanitary Facilities: ° 0 ° <br /> 1. Work: 2. New Building Details No. Bathrooms ...2..... <br /> SN <br /> New Building .......... Type of Construction: No. Bedrooms ...q..... �. i '• <br /> Addition Septic Tank Size Gals. .......... :� <br /> w :r <br /> Sanitary x.. Size .............. ft. x .............. ft. Holding ank 3000... <br /> ld Site <br /> g <br /> i <br /> Absorpton e : <br /> Filling/Grading .,........ Height............. Stories ............... 4a. :e Y <br /> SoilType ...................................... <br /> Moving .......... Area ........................................... cr <br /> Slope ............................. ........... <br /> fs <br /> Mobile Home .......... F 9 <br /> Privy .......... 3. Use (describe exactly, 1 -family <br /> Pere. Rate ......................... <br /> oa..... w <br /> n h <br /> Well ,......... home,garage, motel, etc.) Dry Well .... ..... w <br /> Seepage Trench .......... W i <br /> Subdivision .......... .................................................... Privy ft <br /> .......... <br /> Camping Unit .......... ............ .� <br /> .... ................................ .. w .a <br /> Seepage Bed .......... u <br /> --------------------------------------------------------------------- .c <br /> Location of proposed structures and existing structures,well, sewage systems, roads, etc., should be sketched in Fig. A. Include road M <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter p _ ' <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING 11a <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o <br /> --- — ----- w W <br /> 5. Lot Size: Fig. A. 6. Location: o <br /> ................ ft. x .............. ft. — ............................... sq.ft. ............................................................................... ° <br /> N <br /> N <br /> n <br /> N O <br /> O = <br /> See State approved plan <br /> #8501368 0 <br /> o <br /> f <br /> yy _ <br /> *U <br /> a <br /> T :OD <br /> :z <br /> z <br /> 0 <br /> C d <br /> w <br /> 0, <br /> 0 M m in z <br /> 0 <br /> v' vNia C . <br /> < m _. m <br /> Zo o n 77 <br /> in <br /> _ 1 j M <br /> G....................� p <br /> j <br /> Signature of Owner or Agent Date <br /> 7 X <br /> �1 1 y T <br /> m <br /> Remarks .......... ... :�...�:fS.?//�:.'............................................................................................................................. � 0 <br /> �/1v?2e..linb.fu.�e. ...4. a1zi:,--............................................................................... _ <br /> .................... i?I.�sz -�s... .'e6 2 d................. .......... .............. ;.................................... <br /> m <br /> ��. L ... 1� � m <br /> II <br /> Inspection Date ....................................... . .. . ...... ....... :J.... ..... .: N N o <br /> U T O O <br /> ZoningAdministrato�� 8 8 8 8 8 o w <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures Involving sanitary facilities <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test trust be attached to <br /> this application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build- <br /> ing until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here <br /> with is found to exist. Changes in plans or specifications shall not tie made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />