Laserfiche WebLink
Burnett County Office of Zoning Administrator on I - Z <br /> 0 o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> p <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as '� o <br /> N <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 Wisconsin. <br /> .....................KENNt.`.LH-2......J4NURICH................. ...........................A,.Rxzw..J.,....t�LLN ............................ � � � o <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT <br /> ..... ..... .........7.10.9... 2�C2...LAKt...TaANk................. .......................... <br /> aooRess.. .. P...4.BOX...7.1...................................... � � ! <br /> ADDRESS """' <br /> ES.,...zZ...5.5.0,14.............. . ........................ <br /> Spooner.:...W ...54801 <br /> ADDRESS ADDRESS .. .. ........................ IS <br /> .......... ..................................................................... ...........................715.-635...7595................................ <br /> PHONE PHONE . <br /> .....................ARLYN...J.....HELI z................................ <br /> PLUMBER WELL DRILLER i1 <br /> .....................S,POONI ....,tYI...5801....................... <br /> ADDRESS <br /> ............................................................................ .o I <br /> ADDRESS -' <br /> 715.-...6 35...7 59.5.................................. 12. <br /> .PHONE.................................................................................... <br /> 0 1-1t <br /> PHONE <br /> DESCRIPTION o <br /> 4. Sanitary Facilities: o <br /> 0 <br /> 1. Work: No. Bathrooms v <br /> 2. New Building Details • ..... <br /> New Building <br /> ..X..... Type of Construction: No. Bedrooms ...3..... 'f1 <br /> Addition .•••••..,......... •4D,,,,•„.....,.•,,,• Septic Tank Size Gals. .......... <br /> Sanitary x.... Size .....30.... ft. x ...22..... ft. HOLDING TANK 20.0.0 <br /> FillingiGrading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .. Soil Type ....................... ..... Area ....... <br /> r- <br /> .......... <br /> .......... .......Mobile Home o <br /> .. <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ......N.QUI.................. 9..3 <br /> Well .......... home,garage, motel, etc.) y <br /> Subdivision ....•.., 7 , Seepage Trench <br /> 1 <br /> 1...:AIZZX...HONIE...... <br /> Camping Unit .......... Privy „........ O <br /> ............................................I....... Seepage Bed <br /> .......... <br /> ------------------------- ---- ------ <br /> w <br /> Location of proposed structures and existing structures,well, sewage systems, roads, etc., should be sketched in Fig. A. Include road l <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 5 <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. (t <br /> _______-__- Y <br /> __________ 0. <br /> 5. Lot l150 Fig. A. 6. Location: ?RI <br /> ................ ft. x .............. ft. . ......I........................ sq.ft. ............................................................................... <br /> SEE ATATTCHED SHEET an <br /> N o <br /> O <br /> 3 lU <br /> 0 <br /> 0 <br /> U � <br /> I T <br /> a <br /> Z <br /> o � <br /> 3 <br /> N <br /> nr w m z <br /> cs <br /> m Non <br /> an .` <br /> m <br /> m <br /> o oo aa7J <br /> ' 70 <br /> MAX 27 198] �� m <br /> .. . .................................... .................. .....x............ _ <br /> Signature of Owner !!F-or Agent Date ° C� _C <br /> X 17 <br /> Remarks ......................................................................................................................................................................... m m <br /> v <br /> ........................................................................................................................................................................................ <br /> .11 <br /> .......................................................................................................... Z <br /> l- YCf��c ............ <br /> j <br /> ... . . ...... . . .. ..... <br /> Inspection Date ....................................... ..... .. . . .. N N m <br /> R N <br /> . .. ......... .. �!” O tTZoning Admini atorg $ o Vr <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilitrn:s <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 he made without approval of the Zoning Adm inistratoi . <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />