Laserfiche WebLink
( t <br /> e.) <br /> Burnett County Office of Zoning Administrator 0 H ki 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> '-* o N <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < H <br /> ;flown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use CD e `\\ <br /> Drdinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a .\ <br /> ,,OSA7/tzli " ru <br /> N P. ° <br /> DWNER( ase print) CON R TOR or SURVEYOR or AGENT a m <br /> ADDRESS ADD ESS m �a\\"' <br /> . rJ� w/ , - v.F7Z q <br /> ADDRESS ADDRESS Y\t, <br /> PHONE PHONE 4 <br /> PLUMBER WELL DRILLER <br /> F. <br /> 0 ` <br /> ADDRESS ADDRESS C <br /> H. \ \ <br /> < <br /> O :-i \ , ` <br /> PHONE PHONE z H N?. <br /> r <br /> DESCRIPTION 4. Sanitary Facilities: •o o o <br /> 1. Work: 2. New Building Details No. Bathrooms <br /> New Building Type of Construction: No. Bedrooms c <br /> k <br /> a) <br /> Addition Septic Tank Size Gals. <br /> Sanitary Size ft. x ft. <br /> Filling/Grading Height Stories 4a. Absorption Field Site: <br /> Moving Area Soil Type r <br /> Mobile Home Slope r+ <br /> Privy 3. Use (describe exactly, 1 -family Perc. Rate <br /> Well home,garage, motel, etc.) Dry Well <br /> Subdivision Seepage Trench <br /> Camping Unit Privy <br /> Seepage Bed <br /> C <br /> Location of proposed structures and existing structures,well,sewage systems, roads,etc., should be sketched in Fig. A. Include road c <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- a. <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING < <br /> N t' <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o <br /> m <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ft. x ft. — sq.ft. <br /> 1.nl73,,i i; <br /> Se c2 5-(r) s � s <br /> 1 I N O' <br /> - O n <br /> l� 1 a� s, Sk . 59 <br /> \./ 4 ' J 0 .p <br /> t ; ` ti <br /> rF <br /> 0 (.., <br /> 0�, d <br /> l CEJ <br /> ' S <br /> ? <br /> ..0 <br /> v <br /> z Z <br /> 0 <br /> a, <br /> (0 <br /> Do cn r cn co z <br /> o . Q - < <br /> � 2' CCD <br /> CD <br /> _ <br /> a <br /> -o ' •< r <br /> - m <br /> z b o' D a <br /> o• a <br /> '\(11 o m <br /> � m <br /> 6-,7 7-c'ry \ o p <br /> Signature of Owner or Agent Date '* — <br /> 7 � X X <br /> Remarks . 1,,ett ier./. '-°' z6'/./73(i ,1 m <br /> e <br /> v <br /> b <br /> NA ii <br /> �` O T <br /> Inspection Date a '77" 111t - 4 �o o P m <br /> v� Zoning Administrator <<u o 0 0 0 0 o N <br /> VOTE: 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 /> ,ng 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 />