Laserfiche WebLink
Burnett County Office of Zoning Administrator Ln - 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT W3, a <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 m � <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a �\ <br /> eN <br /> I-.L.F <br /> M.,. .t. . .. ....U.:.....Wa..t+.a.u.......... . ... ... ....................................................................... <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a <br /> Wf .. ......................................................................................... o- <br /> d <br /> ADDRESS ADDRESS <br /> ........................................................................................... ............................................................................................ <br /> ADDRESS ) ADDRESS �� <br /> PHONEN//i.G7...-.../..5...: . ......................................................... .PHONE................................................................................ <br /> �y <br /> .................................. ................ <br /> ........................................................................................... . . .................................. . <br /> PLUMBER WELL DRILLER <br /> 7 <br /> ADDRESS ADDRESS c <br /> o <br /> ........................................................................................... . .......................................................................................... <br /> PHONE PHONE Z H r- <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms .......... o <br /> No. Bedrooms <br /> New Building ,,,,�. Type of Construction: <br /> Addition ,,,,I,yJ,?,U.,a...`R:.q.fA C„•••••,••••.• Septic Tank Size Gals. .......... i <br /> .......... <br /> Sanitary .......... Size ....e?.,`.!.... ft. x ....t�. . .... ft. .......... <br /> 0 4a. Absorption Field Site: �' '• <br /> Filling/Grading .......... Height...l..:.:.... Stogies ....l.......... i <br /> ....... <br /> Moving - Soil Type ............................. i r <br /> Area ... ..l.G..w. ..Y.F................... o i <br /> Mobile Home .......... Slope .......................................... Com' .. <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... G <br /> Well .......... home,garage, motel, etc.) Dry Well ...I...... <br /> Subdivision Seepage Trench .......... <br /> .......... ....lz..A.�,k. li............................ <br /> Privy <br /> .......... <br /> CampingUnit .......... ................... ................................ 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 .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 l H <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. f 3 <br /> _—_— -------------------------------- ------- <br /> 5. Lot Size: Fig. A. 6. Location: <br /> J.4 y...... ft. X ..'//C... ft. — .... .�1.�1.`/�.)........ sq.ft. •.�kG �?a:!L)..L!-:1'?.... SC..�. ......:rcw..K��. <br /> Q <br /> 0 <br /> j�LIA k <br /> Pit <br /> O <br /> A <br /> \ i a <br /> O <br /> 9 jf.w��-eE <br /> a” <br /> v` y <br /> N <br /> C d < p c N <br /> �a 2 < <br /> J, N <br /> o o5, 0 <br /> n ' <br /> Z9 3 <br /> � : � <br /> �a <br /> a v- f0 <br /> T41�n�at,�kO <br /> ....... ... .......................... o . . . . C <br /> ner or Agent Date <br /> X <br /> „ m <br /> Remarks ......................................................................................................................................................................... p <br /> m : <br /> ........................................................................................................................................................................................ EpU <br /> ;V 11 <br /> ...................................................................................................... ... . . . .................... <br /> � Uo � o m <br /> Inspection Date ....................................... t• <br /> . . ........... m <br /> Zoning Adminisator <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 />