Laserfiche WebLink
Burnett County Office of Zoning Administrator T o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 0 <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as < m <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use T <br /> Ordinance, Sanitation Code,and with all other applicable Count Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> County 9 <br /> eN..A � .... ..00C�w.Ll ......... ..I..... . ............... <br /> OWNER (please pnn�.+�, CONTRACTOR or SURVEYOR or AGENT a <br /> IONVC-IE ................ a <br /> .....I.q .. ......... ....................... 1 v ..................... <br /> ADD SS n ADDRESS ;CS <br /> St �3 c LC. �/� tU SSn <br /> r .4�...........................................,....... ................. ....................................................................... <br /> ..................... <br /> ADDR SS ADDRESS <br /> ..1. - ...Y5f 57.--,;:;L: 4.................... ............................................................................................ <br /> PHON PHONE i E� <br /> .......... <br /> ........................................................................................... . . . . .DRILLER... I'L,L.............................................................. <br /> PLUMBER WELL.. _ \ r <br /> O_ <br /> ADDRESS ADDRESS n 0 <br /> D < <br /> ........................................................................................... . . ............................................ ......................... H <br /> .............. o ,» <br /> PHONE PH..O..NE Z r <br /> DESCRIPTION 4. SanitarvFacilities: ° o ° <br /> Bathrooms """"" ` <br /> .13 <br /> 1. Work: 2. New Building Details No. c <br /> New Building .......... Typ of Construction: No. Bedrooms .......... <br /> Addition ..., )[l.�.T//}(. ..................... Septic Tank Size Gals. .......... !�.1 <br /> .......... <br /> Sanitary .......... Size .—.......... ft, x ft. """"" <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Type .................................... :� r <br /> Moving .......... Area ........................................... Soil <br /> .......... o <br /> Mobile Home $IOPe .......................................... <br /> - i <br /> Fare. Rate ................................... .y� <br /> Privy ...... 3. Use (describe exactly -family � <br /> Well <br /> .,X., home,garage, motel, etc.) Dry Well ..... <br /> Subdivision <br /> Seepage Trench .......... <br /> „ <br /> Camping Unit .......... .................................................... Privy .......... yi <br /> Seepage Bed <br /> ___________________________________________________ ------_----- :tit <br /> Location of proposed structures and ex isung structures, well, sewage systems, roads, etc., should be, sketched In FIg. A. Include road t On <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 i o <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. ^�. o <br /> - _.---------------------------------------- ------___-- x <br /> o�JJ <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... sq.ft. ................................................ G <br /> is, <br /> N <br /> � • <br /> 2 ' <br /> an rW Z <br /> C d � � m d c N <br /> NN a n < N f <br /> -. Ca IP <br /> a U < 0 <br /> oN � am <br /> a ; 70 <br /> m <br /> t4�Q.... .................. ........ <br /> m <br /> p <br /> Signature of Owner.. ..or A t Date o . C <br /> /e� <br /> Remarks ..........lJ..'.'.. . �f <br /> .G.I....!/ . J.....1/.P...... .......lx�. m :`. .... ..:: ...... / .d x . O <br /> ........................ .5... !(Ko ..,. ................................................................................................. <br /> .. <br /> :\ <br /> Inspection Date % ~_ 'oo, o o <br /> Zoning A inistrator 8 0 0 <br /> NOTE. A preliminary site Inspection must be made and site approval granted on all structures Involving Sanitary facllitics <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 of start any build- <br /> ing until a permit has been issued. A permit may be revoked It misrepresentation of any of the information conveyed here- <br /> with 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 />