Laserfiche WebLink
Burnett Coupty Office of Zoning Administrator 2� 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 < i 0 <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 2- <br /> CL 0 <br /> .�441Fi ',i7`T...... :...G4 s ................ ............................................................................................ <br /> OW R (please print) CONTRACTOR or SURVEYOR or AGENT a <br /> zzf <br /> :..f ................................................................... ..............,....,........................................................................ <br /> ADDRESS ADDRESS <br /> Gv13ST�iQ Vit//S, 55�89, .............................................................. <br /> ADDRESS ADDRESS <br /> ........................................................... . .......................................................................................... <br /> :moi <br /> PHO ••• !/_ ...(... <br /> .. . .....G�....../(... <br /> ...... ... .SO/!/.................. PHONE.............................,..............................................,.... :W <br /> PLU ER WELL DRILLER <br /> iy <br /> .................................... <br /> .. ......... , t S.. .. .. / .�........... :�O o <br /> ADDRESSADDRESS ( 0 o O <br /> .......................... .......................................................................................... W <br /> PHONE PHONEZ 0 <br /> DESCRIPTION 4. Sanitary Facilities: / ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms O o <br /> r� 1 <br /> New Building ........ Type of Construction: No. Bedrooms ..?.. <br /> E <br /> Addition S ptic Tank Size Gals. i <br /> �D yG iikvk...� of <br /> Sanitary Size .............. ft. x .............. ft. � ;V E� <br /> �••' 4a. Absorption Field Site: U ; O <br /> Filling Height............. Stories ............... <br /> Moving Area ............... Soil Type ....G��'.................. r <br /> E� <br /> Grading Slope .......... .....Q...... <br /> ............ <br /> Mobile Home 3. Use (describe exactly, 1 -family Perc. Rate .........,l1/.. ............... 1 <br /> Privyhome,garage,motel,etc.) Dry Well .......... \ <br /> Well Seepage Trench i <br /> SubdivisionPrivy .......... <br /> .......... .................................................. . 1 <br /> Seepbge Bed .......... ,p <br /> Location of proposed structures and existing structures,well,sewage systems,roads,etc.,should be sketched in Fig. A. Include road a <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING T. <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. O' <br /> ---------------------------------------------------------------------- <br /> Q 7 <br /> 5. Lot Size: Fig. A. <br /> Q <br /> ................ ft. x .............. ft.— ............................... sq.ft. N 08 <br /> o � <br /> 0 <br /> b0 <br /> N <br /> _S <br /> T� <br /> -n V <br /> y� Z <br /> : d <br /> 7 <br /> l Aw <br /> 7p an r--o W <br /> m Cd2.� dc <br /> �• Nao.< -� aC <br /> O H N ~ W <br /> Z <br /> O <br /> N "I <br /> .0 <br /> 13 <br /> Signature of Owner or Agent Date <br /> T X : : m <br /> Remarks' <br /> ........................................................................................................................................................................................... <br /> ..................................................................................................... /-' ....... <br /> ... ........... <br /> o , 'C <br /> m <br /> InspectionDate ....................................... ........... . . ... ............,... <br /> ging Admitt o v <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 />