Laserfiche WebLink
�1s fuAIS Rd lz •,2 7 ?y <br /> Burnett County Office of Zoning Administrator j CD 0 0 <br /> APPLICATION FOR SANITAfA(,— LAND USE — BUILDING PERMIT rt <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as 0 + :V <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use CD <br /> _ c �� <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a 34 <br /> O <br /> Lu �..rnlr>IT..suL$..car.............................. ............................................................................................ y <br /> OWNFGR (please print) CONTRACTOR or SURVEYOR or AGENT a <br /> .......DRANTS3URG WI....74M......54840................ ............................................................................................ o <br /> ADDRESS ADDRESS <br /> CD <br /> ..AD..........RESS.... ............................................................................ ; <br /> ADDRESS D i <br /> 689-2347 <br /> ........................................................................................... ............................................................................................ �o <br /> PHONEDonald Daniels PHONE <br /> ......................................................................... .................................................................. <br /> PLUM WELL DRILLER �a <br /> PLUMBER III 54872 <br /> o <br /> ............... .......................................................................... ............................................................................................ <br /> ADDR <br /> E493-2333 0 o <br /> PHONE PHONE <br /> DESCRIPTION 4. SanitaryFacilities: o o <br /> 2 <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details :\ o <br /> New Building .......... Type of Construction: No. Bedrooms 4... `C - <br /> 128© `° <br /> Septic Tank Size Gals. ......... <br /> Addition .......... ...................... ........................ c�" <br /> Sanitary x,,... Size .............. ft. x .............. ft. existing .......... <br /> Filling ••.......• Height............. Stories ..............: 4a. Absorption Field Site: <br /> Moving Soil Type .................................... :' r <br /> .......... Area .......................................... o <br /> pGrading .......... Sloe .......................................... <br /> Mobile Home ......•... 3. Use (describe exactly, 1 -family Perc. Rate ................................... i <br /> Privy home,garage, motel, etc.) Dry Well .......... <br /> Seepage Trench .......... <br /> Well ..MaAajer'.s..s.ingl.e...£as►i iy <br /> Subdivision Privy i <br /> .......... ..............hawse............................ <br /> Seepage Bed .......... i <br /> ---------------------------------------------------------------------- <br /> Location of proposed structures and existing structures,well,sewage systems, roads, etc.,should be sketched in Fig. A. Include road C <br /> o' <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. H <br /> o---------------------------------------------------------------------- <br /> 5. Lot Size: Fig, A. 6. Location: <br /> ft. x .............. ft. — ............................... sq.ft. ............................................................................... <br /> m <br /> 0 <br /> N O <br /> o <br /> rt <br /> �. T <br /> CD <br /> 0 <br /> d <br /> cn <br /> �m <br /> :sW <br /> 70 r CD co Z <br /> T. Naa•G - '+' Q <br /> cn < C: m 5• 0 '0 <br /> m <br /> Z 0 0' fD CD 70 <br /> ° > >' <br /> ........ .1..�. -�o��L r ID........................ : <br /> Signature of Owner or Agent Date <br /> X <br /> Remarks -n 0 <br /> CD <br /> • � ; E <br /> ............................................................................................................................... ...................:................:........... ; 00008U'lm <br /> . . . . <br /> � <br /> InspectionDate ....................................... S%tl: ....... ..... . ................................ : ' 0 0 0 0 0 o m <br /> Zoning Administrator o 0 0 0 0 o cn <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> aefore 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 /> ,g until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> h is found to exist. Changes in plans or specifications shall not be made without approval of the Zoning Administrator. <br /> 'EWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />