Laserfiche WebLink
Burnett County Office of Zoning Administrator CD 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 o <br /> d o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < HO <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m c � <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> ......IA.N......j . �.............................................. ....4' . ............................................ y <br /> a <br /> m <br /> CD <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT.0 CD <br /> n <br /> r.! .... .�1...... .0.1�............................................. J. ! rZ.�V/...T/��J........................................................... a <br /> . C <br /> ADDRESS ADDRESS a) o J <br /> �s..3... . .. ... '0... ,.7............................................. ......................................................................................... � <br /> ADDRESS ADDRESS <br /> .................. ........................................................................................... <br /> PHONE PHONE <br /> .......... <br /> PLUMBER WELL DRILLER ?}� <br /> T- <br /> ......................................................... <br /> ADDRESS ADDRESS <br /> 0 o <br /> PHONE PHONE <br /> DESCRIPTION °0 <br /> 4. Sanitary Facilities: ° o <br /> 1. Work: 2. New Building Details No. Bathrooms <br /> o :� <br /> No. Bedrooms : <br /> New Building •.,....... Typ of Construction: •••••••••• � <br /> 47) <br /> Addition •• /`�/�,IYJ•F,,•„• , Septic Tank Size Gals. .......... <br /> Sanitary <br /> Size ... .Q..... ft. x ...Z..Z.,.. ft. <br /> Filling ...•....•• Height....AOFTtories .... ......... 4a. Absorption Field Site: <br /> Moving .......... Area ...P,f�,�j,Z..... .Q....F�'...... Soil Type .................................... m <br /> Grading .......... Slope .......................................... ° <br /> Mobile Home 3. Use (describe exactly, 1 -family Perc. Rate ................................. . <br /> Privy •....•••.. home,garage, motel, etc.) Dry Well :�� <br /> Well .......... �1 .44'A.(� D..91.....�4,c Seepage Trench <br /> Subdivision Privy .......... r <br /> Seepage Bed .......... <br /> -- ---- -------------------------------------------------------- N <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc.,should be sketched in Fig. A. Include road <br /> s ' <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- o <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. `— <br /> o' <br /> ------------------------------------- <br /> 5. Lot Size: _ Fig. A. 6. Location: <br /> 1..O..Gt..... ft. x ,S Q ... ft. "+ <br /> J.... Q............. sq. ft. 4.i... ..�a............................................................ <br /> m <br /> N <br /> n <br /> o 7 <br /> o �lNx 0 <br /> r-F <br /> x <br /> r?ARA E/8eAr z <br /> f '0 <br /> 'k za 276 " <br /> '70 <br /> cnr � � cn00Z <br /> �, m. Naa< �' Q � <br /> w a cn < C , <br /> i Z o o fD <br /> o S �. <br /> i!L.. .... .... .... ".�..�-3..... o p <br /> Signature of Owner or ent Dafe <br /> • X 7I7 <br /> Remarks ......................................................................................................................................................................... n mm <br /> CD <br /> ........................................................................................................................................................................................ <br /> ......................................................................................................... ............................ ............................................. . : <br /> Inspection Date ....................................... lkfi!r2,q, :.. .... . ...... .irk.................. '�: o 0 0 0 0 o m <br /> Zoning Admi i' or 0 0 0 0 o 0 <br /> DOTE: 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 /> his 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 /> vith 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 />