Laserfiche WebLink
Burnett County Office of Zoning Administi ator in 7 c � <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work describeand •Z <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements f the <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the law and 3 <br /> �regulations of the State of Wisconsif. .Q <br /> L CHL. .. ......... ...........5e,/ ..—....:.................................. ........ � 3 <br /> �.l4f�ry... ........ .. '. ►: @ ................... <br /> fns � Tt <br /> OWNER (please print CON TR R or SU RVEVOR or AGENT <br /> 519.2 !:esr. a�.. .... ' .L.�'..O a <br /> ................. . ...... . . ...................................................................... ........ <br /> ADDRESS ADDRESS :.0 <br /> f!1n. .. ........ .t ...........5.�.:3�..Y............... ................................................................................... . <br /> ADDRESS ADDRESS <br /> 1 <br /> PHONE PHONE ..... <br /> ........................................................................................... ....WELL DR............ILLER................................................................... ........ <br /> PLUMBER 'D <br /> :z <br /> 0 :a <br /> ......................................................................... ........ .. ..................................................................... ........ _. <br /> ADDRESS ADDRES.. ..S n o M <br /> ................................................................................ . .......................................................................... ......... o :r <br /> PHONE PHONE....... Z H <br /> DESCRIPTION 4. Sanitary Facilities: P o <br /> 1. Work: 2. New Building Details No. Bathrooms ........ c <br /> New Building ,,,,,,,, , Ty of Construction: No. Bedroo ......... R r <br /> Addition � ,��.�:r4i:!.t.., , Septic T k Size Gals. p <br /> Sanitary Size ....1.1....... ft. x ...1..10...... ft. ......... ` :6— <br /> Filling/Grading „-„ ,,.,, Height.l.'�”. Stories,.n..�........ 4a. Absorption Field Site: <br /> Moving .......... Area .....°,.a�..".1....5. . .�........ Soil Type .......................... ......... i r o <br /> i <br /> Mobile Home .......... Slope ............................. .:....... 0 <br /> Privy •••....... 3. Use (describe exactly,-1 -family Perc. Rate ............. ...... <br /> Well .......... home,garage, tel td.l Dry Well ......... _ <br /> Subdivision .......... .J(.fil' .^... �...: Seepage Tre ......... <br /> Camping Unit .......... Privy ......... <br /> .................................................... <br /> Seepage Bed ......... <br /> -- N <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. C o <br /> Include road setback,side and backyard dimension and location and setback from all bodies of water. If property is loc ted at <br /> � g <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the interse tion. cvn, N <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o <br /> ------------------------------------------------------------------ --- <br /> 5. Lpot S' e: /. Fig. A. 6. Location: <br /> ...f..�..... ft. x 2' 3.. ft. — ..+..�5.'...'�....... "Wftr .................................................................... .......... <br /> F <br /> e <br /> W i4mer cu 4:1 'e lU N o <br /> �- O <br /> 0 <br /> �e o C c <br /> �10e I <br /> feet's'zo <br /> a,+, <br /> s 6 ej Ak)fe-J o•. ,�u <br /> N c N N n W a -00«cr - - m <br /> NN <br /> mass <br /> o < d c N > > 3 <br /> SN : O m m <br /> Z S o .� D 1 <br /> o Nom . No. <br /> c o m <br /> 9 . ............ p, <br /> 9 <br /> ,gnature of Owner A.gent. . ..... Date". o <br /> Remarks ............................ .......................................................... .......... .......... .... _ <br /> T : <br /> Urr� Gr ( // <br /> 1'w<� S.li t^ '.f.. .. 4Y�c/cot–i n ....1 d g <br /> 8 <br /> ................................. . ........ .. <br /> � � � � m <br /> InspectionDate ....................................... ..... .................... .................... ..... ........ ...... . . m <br /> Zonin Admini r g g g N <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary f cilities before construct n <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this application before a permit v II <br /> be issued. Do not purchase or install a septic tank,do any plumbing or start any building until a permit has ben issued. A permit may b <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or specifications shall not.be <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE ANDA PROVED. <br />