Laserfiche WebLink
I. <br /> r.. - <br /> , 7 /' <br /> Burnett County Office of Zoning Administrator U ' o 0 <br /> APPLICATION FOR SANITARY — 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 < o <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 /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a �"V U-\ <br /> � 77�� ���,lt) l} { /Lyn \/\]�1 y.��pey J� o- 0 <br /> til CD <br /> SUNER (pl se prin9e/uo <br /> ( CONTRACTOR or SURVEYOR or AGENT ...,. <br /> m m <br /> ADDRESS .f lESS �..(i(Ij Q .- is. <br /> ADDRESS °: C\ <br /> ADDRESS ADDRESS < 1 "4 <br /> IN <br /> PHONE <br /> PHONE <br /> PLUMBER WELL DRILLER <br /> 0 C�-- <br /> ADDRESS ADDRESS <br /> rt 0 <br /> PHONE PHONE Z ? • '`c{' <br /> DESCRIPTION r 1� <br /> 4. Sanitary Facilities: ° o ° . <br /> 1. Work: No. Bathrooms - <br /> 2. New Building Details <br /> 4 <br /> New Building Type of Construction: No. Bedrooms .63 <br /> 1s <br /> Addition Septic Tank Size Gals. I <br /> Sanitary Size ft. x ft. <br /> Filling Height Stories 4a. Absorption Field Site: <br /> Moving Area Soil Type r- <br /> Grading Slope ° <br /> Mobile Home 3. Use (describe exactly, 1 -family Perc. Rate <br /> Privy home,garage, motel, etc.) Dry Well <br /> Well Seepage Trench <br /> Subdivision .r/ Privy <br /> Seepage Bed <br /> Location of proposed structures and existing structures,well,sewage systems, roads,etc.,should be sketched in Fig. A. Include road co- <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- Q <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. 6 <br /> o' <br /> c <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ft. �xff �/i ft. —/� m sq.ft. <br /> 5., <br /> CD <br /> V (11 kS <br /> o <br /> 0 <br /> v <br /> Co <br /> G <br /> 4.9 m c <br /> CD <br /> M <br /> — a) <br /> 7 <br /> CD <br /> Vt <br /> M) u^-, r2ii * cnwZ <br /> cD <br /> , c a) _. (D v c cD <br /> N N'QQ s--- .< — . <br /> -o cn < C a' -' 0TJ <br /> Z 0 o' `D : CD 7p <br /> ° c V 3. g <br /> '.0 o —I <br /> • 0 m <br /> signature of Owner or Agent Date — <br /> o C <br /> x 70 <br /> Remarks „ SLt m <br /> CD <br /> 0 <br /> 1441 Ti <br /> CA kg <br /> nspection Date ci7n4,, 7A2 -, \c o 0 0 0 o cNii m <br /> Zoning Administrator '1/ 1 o 0 0 0 0 0 <br /> OTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> efore construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> )is application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build- <br /> ig until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> ith is found to exist. Changes in plans or specifications shall not he made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />