Laserfiche WebLink
c4 <br /> Burnett County Office of Zoning Administrator <br /> '- <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <br /> 3 <br /> ^' <br /> o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described andM C'� <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the ,S �o <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations off-the State of Wisconsin. <br /> �k ........ 1C Q............................................ ........................................................................ <br /> 4 <br /> OWNER (please print) _ CONTRACTOR or SURVEYOR or AGENT d f <br /> g. .... h ,......N..�=......................... . ...... ................................................................................... d <br /> ADDRErADDRESS <br /> l S Wv. to <br /> ADDRESS ADDRESS <br /> s...:....yes.y................. ........... .............. .... ........................................................ I <br /> PHONE PHONE U �� <br /> 0 .t.d.'. . .y-... . . ` (........... ................... `......................................................................... <br /> PL <br /> WELL DRILLER <br /> Flr... ... ...... ... .................................................................... ............................................................................................ c <br /> ADD ESS ADDRESS m <br /> a�..K.l .. . ............................... - - <br /> PHONE PHONE v <br /> 9 ,�„ 0 <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> 1. Work: 2. New Building Details No. Bathrooms fl o <br /> New Building .......... Type of Construction: <br /> Addition Septic Tank Size Gals. .......... Xl <br /> Sanitary Size .............. ft. x .............. ft. 0. d <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: W ( i� <br /> Moving .......... Area ......................................... <br /> Soil Type .................................... rT <br /> Mobile Home Slope .......................................... <br /> ........ . v o <br /> » ; <br /> Privy 3. Use (describe exactly, 1 -family Perc. Rate ................................... ? V <br /> Well ........ home,garage, motel,etc.) Dry Well .......... <br /> subdivisionSeepage Trench o <br /> Camping Unit Privy .......... <br /> .......... .................................................... :^ , <br /> Seepage Bed .......... *^ <br /> _ ___________________________________________________________ � CA <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. :(,J) C <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is located at <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersection. `— <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. 1 o <br /> ______________________________________________________________________ F_IN <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. . ............................... sq.ft. ............................................................................... ,(rprr <br /> n <br /> N p <br /> O <br /> O <br /> O <br /> 0 <br /> 0 <br /> f <br /> s <br /> lv T <br /> A o <br /> W <br /> w <br /> e� <br /> co C3 <br /> � � 000CE <br /> ---- — n to v < o o - - m <br /> m Nnc am nam <br /> ` — o <br /> 07 ; <br /> n� Nn <br /> o _ n . m <br /> o c 0 m <br /> o <br /> M <br /> ... m <br /> �..... X : : �\ <br /> Signature of ner or Agent Date c C <br /> N <br /> Remarks ..... m n <br /> . ................................................................................................................................................................... <br /> O : p <br /> O <br /> }nr n jiN n <br /> Inspection Date ....................................... ..... 1 : ....... .. .... . �,... ............. o o v, m <br /> Zoning Adminis ator 8 8 8 g V <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities before construction <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 will <br /> be issued. Do not purchase or install a septic tank, do any plumbing or start any building until a permit has been issued. A permit may t• <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or specifications shall not <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />