2011/09/21 - SANITARY - SAN - Other

Home Browse Search

Burnett County ON COMPUTER/SCANNED Office of Zoning Administrator d o 0 APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3' = o TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as — :O shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use � c J •'Q, �. ith all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 au V o 11 0 NER (please rint). CONTRACTOR or SURVEYOR or AGENT a p _ .�....... �..D..�.. .4.n......................... ............................................................................................ ADDRESS ADDRESS .................S ADDRESSADDRESS ................................................................ (nt PH........................ ............................................................. .PHONE ..1.L.l.G: .P�' �1/(p/��1�). . ................................................................... . . . .— ................................................................................ PLUMBER WELL DRILLER p A .......... ........................................................................................... ADDRES'E'S"S................................................................... ADDRESS i 1i.1 0 o 0 . . .................................................- 'P.........E.................................................................................. - o PHONE Z DESCRIPTION 4. Sanitary Facilities: 0gr 1. Work: / No. Bathrooms - (/ 2. New Building Details ° ' 0 New Building ..... Type of�Construction: No. Bedrooms ....�. :O Addition I �a"r+.t Septic Tank Size Gals. .........� v ....... .... .. ........................ ........ .. , p1 .. C Sanitary ,...✓ Size .....tY.O.. ft. x ..�.�..... ft. .7....... Filling ......,,,, Height............. Stories ............... 4a. Absorption Field Site: Moving .......... Area Soil Type .................................... r Grading ... Slope .......................................... .......... Mobile Home .......... 3. Use (describe exact) -Tamil Pere. Rate ................................... Privy / home,garage, motel, .) Dry Well .......... �g : Welll./ Seepage Trench .......... .......................I........... ................ yyyyyy Subdivision ......... Privy oo I1 --------------------- -------- --------- Seepage Bed �.4....... ------------_ m rr.7 Location of proposed structures and existing structures,well, sewage systems, roads,etc., should be sketched in Fig. A. Include road setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- section, show the intersecting highways and the setbacks required along them and at the Intersection. CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. —' — -------------------------------------------------------------------- o _ 5. Lot Size: Fig. A. :V) ................ ft. x .............. ft. — ............................... sq.ft. i rn O o ' E E w U 01 _ JE0 0 w'�II vl jad r— "1 baa< � r; o N _. =m m � O o 00 3 N O � s-s-za � p §Ig" ... ...................... ........................................ ....................... - i C Signa re of Owner Agent Date � � M x m Remarks ............................................................................................................................................................................ Z a" ........................................................... ......................................................................................................................................... ................................................ : tl a: 4l/.:.05.:...t ....... .. ...d... :t.l............................... o ch o o m Inspection Date ....................................... �LC!C-G'—L bob ' b m ZoningAdministrator 000 01 NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities before construction 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 be issued. Do not purchase or Install a septic tank, do any plumbing or start any build- ing until a permit has been issued. A permit may be revoked If misrepresentation of any of the information conveyed here- with is found to exist. Changes in plans of specifications shall not be made without approval of the Zoning Adm inlstratoi . SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED.