Laserfiche WebLink
Burnett County Office of Zoning Administrator d o' " o <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 — <br /> shown 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 Ordinances and the laws and regulations of the State of Wis onsin. 3 <br /> h.A'Li...S..........A -. .S.t .Y.................... ................................ . ... .. . ... .... ..... N <br /> ... . .... ....... ...... .. <br /> . <br /> OWNER <br /> ease <br /> print) CONTRACTOR or SURVEYOR or AGENT <br /> ADDRE..... J.. .�Y <-... c l e f✓ < a P . <br /> 3 <br /> ........................ .....:K.................... ................................................................................. .......... <br /> ADDRESS m <br /> / q I <br /> .......:J.SF.." !: ...l...f?.!:f..�......:.J.TJ L 'H"....::...`.:.'....�:�. . ............................................................................... .......... i iGQ E <br /> ADDRESS ADDRESS t <br /> :V)........................................................................................... ................................................................................. .......... <br /> PHONE PHONE <br /> PLUMBER WELL DRILLER h^� <br /> :W <br /> ADDRESS ADDRESS <br /> n o <br /> e <br /> PHONE PHONE ZH <br /> r <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details .......... o <br /> New Building ,,,. . Type of Construction: No. Bedrooms .......... <br /> Addition r'f Q...%'i..'./.f. Septic Tank Size Gals. .......... <br /> Sanitary <br /> ......I... Size ....::r.'.:5... ft. x ... r�,E:... ft. .......... i <br /> Filling/Grading ,,,,,,,,,, Height Lr.I.�L.'� Stories ....../........ <br /> 4a. Absorption Field Site: <br /> Moving .......... Area Soil Type ......................... .......... r <br /> .................................. ........ Slope 0 <br />' Mobile Home P ............................... .......... yam. <br /> Privy .......... 3. Use (describe exactly, 1 -family Pere. Rate ........................ .......... -y <br /> Well ,,........ home„ rage-dmDry Wellotel, etc.) .•.•...... <br /> Subdivision ��-- - Seepage Trench ....... <br /> ........../�..1�.n. .. ..................... <br /> Camping Unit .......... ..........1�1."f.Ff.0.rJ..�. Privy .......... i <br /> Seepage Bed .......... 9 i <br /> ----------------------- <br /> -------------------------- <br /> --- <br /> -- j <br /> cn <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc.,should be sketched in Fig. A. <br /> Inclu a road <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highw y inter- <br /> ST <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EX TING <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. (n <br /> ------------------------------------------------------------------------ <br /> It o <br /> 5. Lot Size: Fig. A. 6. Location: ( ,t ' <br /> ..�S.C>..... ft. x .-y.�:.�'. ft. — ............................... s ft L�./.1...... .”Il.. :".E.L.P:.Y?....................... 1.1 <br /> q. ............ ... <br /> — CJs <br /> o s' <br /> 3 V <br /> � = 0 <br /> I = � <br /> O <br /> 4V �� /�[ <br /> o i <br /> m <br /> i <br /> m <br /> c ILg E _' <br /> ry Is <br /> X N r m z <br /> n ea, <br /> _ F <br /> L hJ `° Name <br /> 'O� t11 < <br /> _ - -- Z O O <br /> mI <br /> mI <br /> Si " ature of Owner or Agent Date <br /> W o = c <br /> :....� . . .... . ..... .Remarks ............................ ; rBig., . . . _..... ........... ....... <br /> m <br /> .... .'....,.,.o.:....1........a............................�...........Y.Y..t.�.G.................L............... . ...............�................................................................. <br /> G : ................................... ................... y.� <br /> T./Q... . <br /> Inspection Date ....................................... .. . .......... <br /> C�.j ✓ .... ..0- in'.g <br /> Admin i for 8 8 8 8 8 <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 pl mhing 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 />