Laserfiche WebLink
Burnett County Office of Zoning Administrator g) 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. o <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as — * :� <br /> N <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 Ordinancesand the laws and regulations of the State of Wisconsin. 3 <br /> a <br /> .............................................. O <br /> H <br /> OWNER e Prin .CON RAC �...�......1.,-.a,{ :.�..or A'G' y............................... <br /> tl............ ... j <br /> TOR or SURV EVOR or AGENT <br /> ........................................................................................... .ADD..... R....ES....S............................................................................. <br /> ADDRESS <br /> ........................................................................................... . .. <br /> A..D.D...R...ES..S-..................... <br /> ..... <br /> .............. <br /> ......... <br /> ............ <br /> ............... ti l <br /> ADDRESS <br /> ........................................................................................... . . .................................................................................. <br /> PHONE PHONE...... .. <br /> .......... <br /> ........................................................................................... . . . ............ ................................... <br /> .......................... <br /> PLUMBER WELLDRILLE.. R <br /> ........................................................................................... .ADDRE...........S................................................................................ <br /> ADDRESS S m <br /> n 0 O <br /> PHONE PHONE Z <br /> ° r <br /> DESCRIPTION 4. Sanitary Facilities: o ° <br /> 1. Work: 2. New Building Details No. Bathroomso <br /> .......... <br /> New Building .......... Type of Construction: No. Bedrooms .......... o '• <br /> Addition .................................................... Septic Tank Size Gals. .......... i <br /> .......... <br /> Sanitary .......... Size .............. ft. x ft. .......... <br /> Filling/Grading .,,,,.,... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area ..................... Soil Type .................................... <br /> ................ Ir <br /> o <br /> Mobile Home .......... Slope .......................................... » ; <br /> Privy ,,,,,,,,,, 3. Use (describe exactly, 1 -family <br /> Pere. Rate ................................... <br /> Well ......,.., home,garage, motel, etc.) Dry Well <br /> Subdivision .......... Seepage Trench .......... 21v <br /> .................................................... <br /> Camping Unit .......... ......................... Privy .......... :� <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 <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 <br /> RUCTU RES AND PROPOSED STRUCTURES AND ADDITIONS. c <br /> --------------------------------------------------------------------- <br /> . Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. . ............................... sq.ft. ............................................................................... <br /> N O <br /> IIou _ L o <br /> - — r ` <br /> r , <br /> ' u h %, o <br /> o <br /> 7 F <br /> 'o. <br /> O <br /> L m In 2 <br /> OD <br /> L. <br /> _ F <br /> �. : D <br /> Z Opn m <br /> ffl - <br /> as <br /> (jj o <br /> o <br /> �m <br /> ........................................................................... 6-/�-.. ............... p <br /> Signature of Owner or Agent Date o C_ <br /> X <br /> Remarks ......................................................................................................................................................................... <br /> M O <br /> ......................................................................................................... ........................................................................... A <br /> Inspection Date ....................................... � � ........ <br /> - . ..7,!LLI .... u a o 8 0 <br /> Zoning Admi Istrator r-�.............. 8 8 8 8 8 8 h <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 />