Laserfiche WebLink
Burnett County Office of Zoning Administrator u 0 O <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3 0� <br /> < = <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as N <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m C <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> Q <br /> ... ...... <br /> . . .................... .... ... .... . .... .. .............. ... N <br /> . . . . <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT m <br /> .a.r.....Cr: ;..x.... .�1:...J- ...t.....1.... ................. ............................................................................................ <br /> ADD ESS ADDRESS <br /> ...... .....V.Y.. ......3,.L......... ..... i <br /> ADDRESS ADDRESS <br /> PHONE PHONE <br /> 7......... ..................J <br /> a..9... ...liltl........................................................................................ <br /> PLUMBER W LDRILLER <br /> .......... <br /> ........................................................................................... ...........ESS......................................................... <br /> .............. O : <br /> Q 7 <br /> ADDRESS ADDR (\ <br /> n o t <br /> ........................................................................................... ........-E................................................................................ <br /> _. <br /> 0 <br /> PHONE PHONE Z H <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: No. Bathrooms . f.... <br /> 2. New Building Details <br /> New Building ... Type of Constryction: No. Bedrooms .: .... ° - <br /> Addition PPJJ .. i Septic Tank Size Gals. .......... ;,X <br /> .......... ...j3/r..t�..�/..:�.tr.S.: A.?. <br /> Sanitary ......"""" Size ..c�,:A+., ft. x ...r��y ft. .... <br /> Fillingf Grading Height.............. Stories ..../`........ 4a. Absorption Field Site: <br /> Moving .......... Area ................................ ........ Soil Type .................................... r <br /> Mobile Home Slope .......................................... o <br /> Privy ... .. 3. Use (describe exactly, 1 -family Perc. Rate ................................... � i <br /> Well .......... home,garage, motel, etc.)�/ Dry Well .......... <br /> Subdivision .......... ......�........ .„�.-h/. �...lK`"pit- -` Seepage Trench .......... <br /> Camping Unit .......... / .. Privy .......... i <br /> .................................................... Seepage Bed <br /> .......... <br /> Location of proposed structures and existing structures,well, sewage systems, roads,etc., should be sketched in Fig. A. Include road Q C <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter an <br /> section, show the intersecting highways and the setbacks required along them and at the 'Intersection. CLEARLY LABEL EXISTING <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. Y 0 <br /> O <br /> --------------------------------------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. —AR ....... sq. ft. ............................................................................... <br /> e <br /> N O <br /> O 7 <br /> O <br /> C <br /> 49 Z t Cti <br /> Fj' N d 4 m <br /> / Ut < w '< m �. m <br /> f n o 0 =. m n ? <br /> �- 6o m � <br /> 0 <br /> 0 <br /> m <br /> : m <br /> p <br /> ........................................................................... ...................................... o C <br /> Signature of Owner or Agent Date <br /> X 71 <br /> Remarks ......................................................................................................................................................................... m m <br /> v <br /> ........................................................................................................................................................................................ [ i : : : : : <br /> . . . . . . T <br /> InspectionDate ....................................... ................................................................................. u U '0 8 0 8 m <br /> Zoning Administrator 8 8 8 8 8 8 rn <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <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 if 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 />