Laserfiche WebLink
Burnett County Office of Zoning Administrator v CD o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. <br /> o <br /> FO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as � * :(—J� <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m :W <br /> Drdinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. a 4 <br /> a <br /> .............. . . ......... o <br /> iT ELF ..M ...NMN........................... �IcT ......... <br /> DWNER (please print) CONTRACTOR or SURVEYOR or AGENT a m <br /> Sl$OCL <br /> 4DDRESS ADDRESS r+ �' <br /> EE 45.1 Ar'S. NI N SS?s31............................... 9 <br /> ................ <br /> 4DDRESS ADDRESS <br /> S6 <br /> 'HONE PHONE <br /> 'LUMBER ��/ WELL DRILLER.............................................. .................................................................... <br /> � <br /> .. • .......................................... p <br /> All ADDRESS <br /> 0 :r <br /> 0 0 <br /> —' <br /> 'HONE PHON.E........................................Y.................................. <br /> ..... o <br /> DESCRIPTION z H 0 <br /> 4. Sanitary Facilities: O ° o ° <br /> 1. Work: No. Bathrooms ....... <br /> 2. New Building Details o � <br /> New Building .... <br /> k No. Bedrooms ...... <br /> Type of Construction: rZ; h <br /> Addition CIe►$tN„•„...............•••.•........... Septic Tank Size Gals. ....0 <br /> Sanitary .......... Size ..;,4..... ft. x ..-�- ...... ft. .......... a <br /> Filling Height............. Storiet /.,��(,�Vicl4)4a. Absorption Field Site: <br /> Moving Area Soil Type .................................... r <br /> ........................................... O <br /> GradingSlope .......................................... <br /> Mobile Home 3. Use (describe exactly, 1 family <br /> Perc. Rate ................................... <br /> .......... ) <br /> Privy ...K.... home,garage, motel, etc.) Dry Well <br /> Well „ C,,,• Seepage Trench .......... ,e <br /> ................................................... <br /> Subdivision Privy Zz : <br /> .......... <br /> .................................................... <br /> Seepage Bed .......... <br /> ------------------------------------------------- ----------------- ^ Cl) <br /> _ocation of proposed structures and existing structures,well,sewage systems, roads, etc., should be sketched in Fig. A. Include road C <br /> :etback, 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 <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o' <br /> ------------------------------------ ---------------- <br /> 5. Lot Size: Fig. A. 6. Location: <br /> o <br /> ............. ft. — -950740.0.......... sq. ft. 55...7*0..Cr.c .{A�.'�'R...Q� ll7................... <br /> Cn <br /> ID <br /> / :s: gam �'%Z E �' Qs \ <br /> -lip <br /> 0 <br /> �, z <br /> 0 <br /> Nm <br /> c m <br /> L. <br /> + o <br /> < Co <br /> `7 CD CD <br /> Ln <br /> o :a <br /> zmm <br /> signature of Owner or Age — <br /> �- � � Privy must be located in x ;�: z <br /> 3emarks ......../.�O....lkgt. .e.....�(l^ � r►,.. .. .�iQ�............................... . CD �i ; 's � <br /> CD <br /> the area of the soil boring a Le at least 25 feet from dwelling, 25 feet <br /> .......................................................................... \ ......................................................................................................... - <br /> � n <br /> from lot line, 25 feet from 20% slope, 50 feet from well, and 75 feet from lake. :C : <br /> c?irrr lJ.. ....7 ............................... <br /> ✓ N <br /> nspection Date ....................................... .............................g . . '�`� . ............... o o • o cn m <br /> :.../C . <br /> Zonin Administrator ��✓ o C 0 o N <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 /> its 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 be made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />