|
Burnett County Office of Zoning Administrator 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 m e E :G`
<br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 n.
<br /> j. . N m
<br /> ................. � r.�af............................ . . ...... . . . .........................................................................
<br /> 'l
<br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT n '°
<br /> 7�.JD
<br /> ADDRESS ...... 01 ADDRESS............................................................................
<br /> ........................................................................................... .A..DD.. RES...i'E'S".............................................................................. �
<br /> ADDRESS S
<br /> ?�
<br /> PHONE
<br /> PHONE
<br /> 1......
<br /> ....J /...!...>°..r.. ..........^. -. ..l.sC'h.... \�1
<br /> V ............... ............................................................................................
<br /> PLUMBER / WELL DRILLER
<br /> -dL/........I-.7.a.r..r..6.n ..�....... ✓A......Y.Y..� ............................................................................................ "` o
<br /> ADDRESS ADDRESS ;� o
<br /> ............ ......................................... =
<br /> ......................................... o .`,'
<br /> PHONE PHONEZ N
<br /> DESCRIPTION 4. Sanitary Facilities: ° o °»
<br /> 1. Work: 2. New Building Details No. Bathrooms ... 9
<br /> o ;t n
<br /> New eullding .......... Type of Construction: No. Bedrooms ...1... :_1
<br /> Addition .................................................... Septic Tank Size Gals. ./..O.�J
<br /> uv V <
<br /> Sanitary Size .............. ft. x .............. ft. ...rR.....
<br /> .......... 4a. Absorption Field Site: p, E
<br /> Filling/Grading ,,, ,,,,,, Height........... Stories ............... 1 :
<br /> Moving .......... Area ........................................... Soil T
<br /> ype ......................S ...... o
<br /> Mobie HomeSlope ..............................f
<br /> .......... .... r
<br /> � O
<br /> Privy .,,,,,,.,. 3. Use (describe exactly, 1 -family
<br /> Perc. Rate ................................... o
<br /> 3
<br /> Well Dry Well -
<br /> ,,.,,,,,,, home,garage, motel,etc.) ����•••�•• �
<br /> See a e Trench ..........
<br /> ... F ` 'J
<br /> Subdivision ...... P 9 ti
<br /> Camping Unit ,,,,,,,,,_ riVy r^
<br /> .................................................... Seepage Bed .d9X?1----------------------------------------------------------------------
<br /> rS
<br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc.,should be sketched in Fig'. A. Include road L C
<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 /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. C N
<br /> o'
<br /> ------------------------------------------------------------
<br /> ---------- — -- —
<br /> --- — — —
<br /> 5. Lot Size: Fig. A. 6. Location:
<br /> i�
<br /> ................ ft. x .............. ft. — ............................... sq.ft. ...............................................................................
<br /> J
<br /> o° o
<br /> n
<br /> N O
<br /> O
<br /> 7
<br /> O gJ
<br /> ^J F
<br /> � D
<br /> -A �s T
<br /> Z
<br /> 0
<br /> d
<br /> n,
<br /> 2
<br /> d
<br /> Z C o m
<br /> o nro 3
<br /> F» —
<br /> �� RA/v c
<br /> 0
<br /> Sign u f Ow_ , Ag/ent Date
<br /> Remarks ... ... 1rZ �C:°Z.`. .:y` T x v
<br /> .......... .................................................................................................................
<br /> m
<br /> .....................I�...../........................................(.�..1 .. ............................. h
<br /> Inspection Date a. .�..`..G...L!.. .. . .7u�. ....kY..................
<br /> Zoning. AdminisNator /t. 8 8 8 8 8 8 rA
<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 /> �7
<br />
|