|
aunty Office of Zoning Administrator --1 0
<br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 0
<br /> ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as — �• :�
<br /> .,.own herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use
<br /> Ordinance, Sanitation Code, and with all other applicable County Ordin ces and the laws and regulations of the State of Wisconsin.
<br /> "CSL/�,. � '\
<br /> OWN). i..... .................. ..�.� ... .IlYL................................ .. ..���¢ ....'��... ...... f./�GLo2.CJ m m 7
<br /> Ilea�pri/n/tl pp CON R CC°' OTT R or SUER/y'..... ..................................................
<br /> �p CC RVVVOR or AGENT a
<br /> Qc�t. ... . /.�........................................... �ti.... .. / y�J �X 70 a
<br /> AD ESS AD -g ESS
<br /> ADDRESS ADDRESS
<br /> ........................................................................................... ............................................................................................ A
<br /> PHONE PHONE
<br /> ........................................................................................... . . . .....................................................................................
<br /> PLUMBER WELL DRILLER .�
<br /> ............................................................::.:.:.........................
<br /> O
<br /> ADDRESS ADDRESSM iv-\
<br /> o0 \\
<br /> ............. . . . ...............................................••. .....••...•••.... .PH....ONE.......................................................................................
<br /> PHONE •
<br /> DESCRIPTION
<br /> 4. Sanitary Facilities: ° o ° ;
<br /> 1. Work: 2. New Building Details No. Bathrooms
<br /> ..........
<br /> New Building ,,,,,,,,,, Type of Construction: No. Bedrooms .......... $ E Addition .......... .................................................... Septic Tank Size Gals. ..........
<br /> Sanitary Size ft. x ft. •• •••••••
<br /> .......... .............. ..............
<br /> Filling/Grading ,,.,,,,,,, Height............. Stories ............... 4a. Absorption Field Site:
<br /> Moving .......... Area ........................................... Soil Type .................................... r i
<br /> o
<br /> Mobile Home Slope .......................................... o .,
<br /> i
<br /> Privy ,,,,,,,,,, 3. Use (describe exactly, 7 -family Perc. Rate ................................... c
<br /> Well .....,.... home,garage, motel, etc.) Dry Well ..........
<br /> Subdivision ✓•,•„ Seepage Trench .......... q
<br /> .......................................... .........
<br /> Camping Unit .......... Privy ..........
<br /> ....................................................
<br /> Seepage Bed ..........
<br /> �f.
<br /> --------------------------------------------------- w •� j
<br /> Location of proposed structures and existing structures,well,sewage systems, roads,etc., should be sketched in Fig. A. Include road w
<br /> setback, side and back Yard dimension and location and setback from all bodies of water. If property is located at a highway inter
<br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING t <
<br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o N
<br /> — ----------------------------------------------- i o.
<br /> 5. Lot Size: Fig. A. 6. Location: 14
<br /> ................ ft. x .............. ft. . ............................... sq.ft. ............................................................................... o
<br /> P
<br /> � r ; 4/J00
<br /> GGG� f 50
<br /> i.J`I N O
<br /> I O �
<br /> 4
<br /> c
<br /> Zr
<br /> ra s� r. I
<br /> z
<br /> m
<br /> i � m
<br /> ::30
<br /> E»c, m c m
<br /> n F
<br /> (NP n C
<br /> m = m
<br /> Z CD n � �
<br /> 0
<br /> 0
<br /> �a m
<br /> Signature of Owner or Agent Date
<br /> X
<br /> Remarks . . .................................................................................................................................... m
<br /> m :LU 0
<br /> m
<br /> ........................................................................................................................................................`.............................. i
<br /> .......................................................................................................... ....................... 10
<br /> ..... ..................................
<br /> Inspection Date ....................................... n... �
<br /> « T
<br /> P .. 'l.'.'•��..l..f.............. m
<br /> ......................
<br /> NN , m , Nm
<br /> Zoning Adminis ator K 8 8 8 8 8 8 y
<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 must 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 be made without approval of the Zoning A Im inistrator.
<br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED.
<br />
|