Laserfiche WebLink
Burnett County Office of Zoning Administrator t iv _CT) V-+ Z <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT ' 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as y o <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Us,, m <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin'. 3 0- <br /> 1.Q.ffir.......... . ..1.. .h............................ h.ohr........................................................... y <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a <br /> F..0,-Hoax...13 A.......Clayton,W-1.....54.1.��# ......................................................................................... <br /> ADDRESS ADDRESS s , <br /> ................................................. <br /> ADDRESS ADDRESS :! <br /> .......... 6.!4.3............r1c; oti�.... <br /> PHONE PHONE ; <br /> ......h.an e................................................................. n on.e.................................................................. <br /> PLUMBER _ WELL DRILLER <br /> :O s <br /> ADDRESS ADDRESS <br /> o <br /> PHONEPHON.E.......................................v............... . :z o : <br /> DESCRIPTION 0 '� <br /> 4. Sanitar Facilities: ° o ° <br /> 1. Work: No. Bathrooms AAhC' <br /> 2. New Building Details ; o <br /> New Building ....X... Type of Construction: No. Bedrooms ......... <br /> Addition ...........St7fwd............................ Septic Tank Size Gals. <br /> Sanitary .......... Size ... ft. .... ft. ......•••• <br /> Filling .......... Height.../.Q:-Ft Stories .....I........ 4a. Absorption Field Site: <br /> Moving .......... Area ......... s�.Q Sf<.f.,t' Soil Type .................................... r <br /> .... ......... <br /> Grading .......... Slope ........................................ 0 <br /> .. ; <br /> Mobile Home Perc. Rate ................................... <br /> .......... 3. Use (describe exactly, 1 -family • <br /> Privy .......... honle,garag Dry Well <br /> mo�.ous. <br /> , etc.) •••••••••• <br /> Well .......... .QQ Seepage Trench .......... <br /> 1 Subdivision CQy�..ex14.rlc� a bJ Seepage Bed <br /> ...C.eY. a .Sla <br /> .......... ; <br /> Location of proposed structures and existing structures,well,sewage systems, roads,etc.,should be sketched in Fig. A. Include road C: <br /> VV <br /> 6 <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- o- <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. L1 H. <br /> 0 <br /> ------------ ---------------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: ^� <br /> �G'F•T..... ft. x .JA. Cz... i. — ............................... sq.ft. T�u1X15I1/ ..f.'1e4'.!lA.[1................... .................... o <br /> �4ke;bar) Acre _N- X� v <br /> �J <br /> Lp <br /> SLAM A Pla mold a 0 <br /> X- ser�id Tanks {,oust 73 <br /> �eAl I <br /> N <br /> r-F <br /> (� 0 <br /> 11 ` aRArsE SHn) ; s <br /> S'�r« Esc b©wT3 C�niQ `� <br /> o <br /> boaf�� � u,t�rtie� one � Z <br /> ceme 4� <br /> �rcu �� cub,n •'\ <br /> s <br /> Moira (Ain <br /> != II M (f)r - CWZ <br /> I L N a a•< 2.CL <br /> :E <br /> otiy �<ngm <br /> o CD " 70 <br /> Weq o <br /> rn <br /> 9� ��;� ... ............ �................. .... /•..//. u•.."' — <br /> ignature of Owner or Agent Date FI4) ° <br /> 1111 I'lC v�q,arn4(,� � x <br /> Remarks ...... ..... ..............hojtfie -In <br /> 0 <br /> .........eu.i. d...a....Wood.....boat-&u$&.......on....an. ....1.ax ' .lr1�....Cer».er��....s14�:..................... <br /> �,.......boat.aia.. a,e ...Tzar:Ier....W.i.4.... <br /> txz�tr.....1 ...... o.....4.a.17 ,�.ua.d..s!..s .6.oat".wt�� o:l� <br /> be S�orrd d/so- <br /> Ins Inspection Date o 0 0 o cNn m <br /> p <br /> ....................................... <br /> Zonin Administrator o C 0 0 o N <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 Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />