Laserfiche WebLink
Burnett County Office of Zoning Administrator o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. o � <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use C <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 cc .0 •� <br /> 6g� RAZ.r,?'5.........�,Kh. ll.r✓..4............... ............JI-4/70S.......Tn�a�sa r ................... <br /> O (please print) CONTRACTOR or SURVEYOR or AGENT ' <br /> .�........,r............�Ye�r..z. 0................ '.......�z........... �,x zz-y a 1 <br /> ........ <br /> ADD..E.. ........................................ ADDRE .......�l............................ <br /> ADDRESS ADDRESS <br /> ..............��G..-..7..1.25...........7. .0�.......... <br /> PHONE PHONE : p <br /> � o.M�EG..........P.AN16itlG , <br /> .......... . . . . ...................................................................... :h� <br /> PLUMBER WELL DRILLER <br /> O <br /> ADDRESS............................................................................ .ADDRESS............;............................................................... m t7 <br /> L. <br /> /.t/ dsr��P.......................................... ............................. <br /> n O <br /> ............................................................... Z N <br /> PHONE PHONE C <br /> r <br /> DESCRIPTION 4. Sanitary Facilities: a ° o °» <br /> No. Bathrooms ......... T : v : <br /> 1. Work: 2. New Building Details o <br /> New Building .......... Type of Construction: No. Bedrooms .......... mi <br /> Addition ... ••, Septic Tank Size Gals. �' <br /> Sanitary •..... Size .............. ft. x ft. .......... y; <br /> 4a. Absorption Field Site: n: <br /> Filling/Grading ,,,,,,,,,, Height............. Stories ............... , <br /> Moving .......... Area Soil Type .................................... •,p: r i <br /> ........................................... o <br /> e <br /> Mobile HomeSlop .......................................... tv <br /> y .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... M <br /> Priv hDpo�eme..g..a.r.a,yg tII.el.V. <br /> . Dry Well Subdivision Seepage <br /> Trench ........../ .Y. <br /> .•........ Privy ..........Camping Unit .......... R <br /> ,I`Io i ii <br /> Seepage Bed <br /> _______________________________________ ____________ 01� <br /> 0 0 <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. Include road <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter a - <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING < <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> o' <br /> ---------------------------------------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. . ............................... sq.ft. ............................................................................... Y <br /> l ao firroIN <br /> 5 0 O <br /> O <br /> O `1 ;(.4j <br /> 0 <br /> J <br /> n m \ <br /> ci m \p <br /> Z C <br /> 0 <br /> u <br /> 1 T <br /> Q_�•� 1 O/ tn�. <br /> 1 Nfj n�� 1 7 mmM : V 0 <br /> 1 0 Q N � <br /> 1 'O 6 < m C � � m m <br /> .�► . am <br /> ........... . .. ....... o <br /> jig*natcre <br /> of Owner o ent Date <br /> y p x M <br /> Remarks ................... .....9� 'r.�.. r 7#..�.F.✓...L.9.:.23.:.� � <br /> m m <br /> ............................................................................................................ ..... .................. ... <br /> Inspection Date ................... ........ % �{'."- {o tr�n m <br /> ................... .. .. ................................................. <br /> ...... ... ... .......................... �l <br /> Zoning Ad nistrator 8 8 8 8 8 to <br /> NOTE: A preliminary site inspection must be made an 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 must he 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 he made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />