Laserfiche WebLink
Burnett County Office of Zoning Administrator0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <br /> o <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 ; <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> !C.!..C.rf .....E.....c%.Q!fy�O.l✓................. N \I o <br /> OWNER (please print) T� CONTRACTOR or SURVEYOR or AGENT <br /> ................................. ............................................................................................ d ' ' <br /> ADDRESS ADDRESS <br /> L ........................ ............................................................................ <br /> .... .......�./(//F.. <br /> ADDRESS .SSILB ADDRESS <br /> ........................................................................................... ............................................................................................ <br /> PHONE PHONE <br /> oN...... .......Bf..f�.T"........................................... ............................................................................................ <br /> "s-\) <br /> PLUMBER _ WELL DRILLER - <br /> `. �//.................... ................ <br /> .. . ....'....... ... ............................................................................ <br /> ADDRESS ADDRESS o <br /> .............................................. ............................................................................................ <br /> o' <br /> PHONE PHONE h [ 1 <br /> Z r <br /> DESCRIPTION 4. Sanitary Facilities: ° 0 0 <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details ""'"" p o <br /> New Building ........., Type of Construction: No. Bedrooms ...,a... <br /> AdditionSeptic Tank Size Gals. <br /> Sanitary „ .....,•, .................................................... <br /> 6X/LTIAIIct :� <br /> ..�.(,... Size .. .. ft. x .. .. ft. <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: 1 <br /> Moving ...... Area ........................... ............... Soil Type ................rA&P....... ! •r <br /> ! <br /> Mobile Home . . .. Slope .................. ... ° ............ <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ................ I............. <br /> Well ,......... home,garage, motel, etc.) Dry Well .......... t <br /> Subdivision ........ Seepage Trench .......... d` � <br /> .. .................................................... .. ... iCU <br /> Camping Unit .......... Privy •' i <br /> .................................................. . .� <br /> ------------------------------------------------- Seepage Bed-----/2-'.>5....._. <br /> r <br /> ti <br /> Location of proposed structures and existing structures, well, sewage systems, roads,ett., should be sketched in Fig. A. Include road Q <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter ,may`. O; <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING - 1 <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. 7 0 <br /> --------------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: <br /> /.O.A....... ft. x ./q6 <br /> .... ft. — .........X 440.0........ sq.ft. .M9.:. .5..pE..................................................... e(j� et <br /> C P <br /> N <br /> m <br /> n <br /> N O <br /> p <br /> 3 <br /> 71113 660 <br /> o <br /> CXl'911V6 /20o 60-Z . rim �3 �ti Coao�J �o�i� � c <br /> G <br /> d <br /> Ll- 0 <br /> N r � Z <br /> I o Q � < m E <br /> »n o <br /> 0L. C <br /> Z 0 m a .Zm1 <br /> o a ro <br /> p <br /> �o c <br /> Set” ner or Agent Date <br /> X : : : 77 <br /> m <br /> . . . . <br /> Remarks 4 .. ..:l .. c �.— - - <br /> .... .... ......... N.. .... ..... ................ ... ........... ...... ................. .... ..... <br /> ................................. .. ..... .... ... ................................................................ ... ........ ........ .... <br /> ............... ...............................a—......4:...................................... T <br /> 1 [ H <br /> .. .. . ............. <br /> `q + ro + m + ro nn <br /> Inspection Date ....................................... .Gr!7.?klr?,.....:... ........!!�'l.'r'.i.:'.'ll............ : E ofp o u, o fp in <br /> Zoning Administrator r o0 8 8 8 8 8 y <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures Involving sanitary facilitins <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 or 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 /> j7 i 132Gz>s C+vf D7 QLCVL2J a '�Jr <br />