Laserfiche WebLink
Burnett"County ' Office of Zoning Administrator M CD o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT . :\ <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as H :� <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 /> CD <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a :\ <br /> �i� ....^.:.... A�4................................ .......................................... N O <br /> :\ <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a <br /> ........... <br /> ADDRESS ADDRESS <br /> v <br /> : <br /> /..�'l././.M/1...5�.55&;��............ V <br /> : <br /> ADDRESS ADDRESS <br /> ........................... ............................................................................................ <br /> PHONE PHONE <br /> c...... ...l�.�rvs.r�/>/......................... ............................................................................................ <br /> PLUMBER WELL DRILLER <br /> ll4.4? TE i.GcJis S 8'9.� ............................................................................................ <br /> ADDRESS ADDRESS ^o C) <br /> PHONE PHONE z N r <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: 2. New Building Details <br /> No. Bathrooms .... <br /> No. Bedrooms 2— <br /> New Building Type of Construction: •••••••••• F�; Co <br /> Addition ..A... Septic Tank Size G Is. R, <br /> ............... ................ -7� ...... <br /> Sanitary / .... Size .............. ft. x .............. ft. <br /> Filling Height............. Stories ............... 4a. Absorption Field Site: y <br /> Moving Area Soil Type ..MP-10.. 1_11J JI ... <br /> .......................................... S . <br /> Grading y�G....................... ° <br /> Mobile Home 3. Use (describe exactly, 1 family Perc.lope <br /> .......... Rate .....mow...:!5.. ....... <br /> Privy home,garage, motel, etc.) Dry Well .......... <br /> Well ... Q.�1, ...... Privy <br /> Seepage Trench <br /> Subdivision .......... .................................................... <br /> 7 .......... ^ :�* <br /> Seepage Bed <br /> -------------------------------------------------------------- cn <br /> Location of proposed structures and existing structures,well, sewage systems, roads,etc.,should be sketched in Fig. A. Include road I O <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- % <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING `� <br /> N <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. p' <br /> --------------- Fig. <br /> -9----- --- <br /> 5. Lot Size: �S Fi A. 6. Location: `' <br /> ................ ft. x .............. ft. — ............................... sq.ft. ............................................................................... <br /> SEA /�r7` C�{E�J P�r4✓lJS �1CD <br /> N O <br /> O 7 <br /> 7 <br /> 7 <br /> rr <br /> O <br /> 7 <br /> a <br /> -n <br /> z <br /> 0 <br /> m <br /> �o un r-NCO z� c CD <br /> LDcQ m <br /> z o o CD �D 70 <br /> o <br /> cn <br /> o <br /> U o 70 <br /> m <br /> .....`..................................................................... .� /3 S�/.. <br /> Signature of Owner or Agent Date <br /> /� X <br /> Remarks G�..��'?k C < , �— CD <br /> - : mp <br /> ........................................................................................................................................... <br /> CD <br /> t: <br /> .......................................................................................................... ......... <br /> (� i- ... M <br /> Inspection Date .............1.............`............ Q!!' ?. ... y ..... ............. <br /> 0 0 o cn m <br /> p Zoning-Administrator c� o o o o cm/) <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 />