Laserfiche WebLink
Burnett County Office of Zoning Administrator d o Z <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as + •�� <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use c "� <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a •lN <br /> - •/ , a }, <br /> ,/.� �. ..................................__-.f��..�:.... .. ..... ...................................... H <br /> m O <br /> OWNE41 (Please print) C N RACTOR or SURVEYOR or AGENT <br /> gJ c <br /> ........................... / ............................... <br /> - <br /> ADDRESS ................. .................. <br /> .................. <br /> ApD/DR/ESS�/ / <br /> ........................................................................................... ADD.. R. .....ES... .............................................................................. :yy <br /> ADDRESS S <br /> ........................................................................................... <br /> PHONE .P. .................................................................................. <br /> HONE....... :N <br /> PLUMBER .W...EL.....L......DR.ILL.....ER..... <br /> ............................... <br /> ........................ .....•••.. <br /> ........................................................................ ........ ......... <br /> . . <br /> ADDRESS .ADD.... .R.ES................ <br /> ............ <br /> ......... <br /> ......... <br /> ........... <br /> ............... <br /> .... <br /> .... <br /> S <br /> n o :t <br /> . . .................................................................... .PHON..E................................................................................ p' <br /> PHONE <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> 1. Work: 2. New Building Details No. Bathrooms .......... i :f <br /> New Building ...•„•••. Type of Construction: No. Bedrooms <br /> .......... o <br /> Addition .......... .................................................... Septic Tank Size Gals. .......... < <br /> Sanitary Size ft. x ft. ....•.•••• <br /> PillinglGrading „•••..... Height............. Stories ............... 4a. Absorption Field Site: <br /> MovingArea ........................................... Soil Type .............................. ..... i f' i 1 i <br /> Mobile Home Slope .......................................... o <br /> ,,,,, •... <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... IJ-) '• <br /> Well home,garage, motel, etc.) Dry Well .......... <br /> Subdivision ✓... Seepage Trench .......... i <br /> .................................................... <br /> Camping Unit .......... Privy .......... <br /> .................................................... <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 `� e <br /> setback, side and backyard 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 /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> _-----__--_— o. <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ft. x .............. ft. . ............................... sq.ft. ............................................................................... <br /> GI <br /> n <br /> 3 V V 3'/5 <br /> m <br /> Z ` <br /> O <br /> m <br /> m <br /> C rj m c N <br /> m a n i = a F <br /> -o b < m c m <br /> Z 00 . D n m <br /> n , M <br /> O �� n m <br /> 6� b <br /> EW m <br /> ................................ <br /> Signature of Owner or Agent Date ° C <br /> X z <br /> Remarks ......................................................................................................................................................................... m m <br /> v <br /> ........................................................................................................................................................................................ <br /> ...................................................................................................... . <br /> . ..... ............ <br /> Inspection Date ....................................... <br /> mQ ..2 ..r.............. � <br /> Zoning Administrator F✓ 8 $ $ $ $ $ $ y <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 revoker) if misrepresentation of any of the information conveyed here- <br /> with is found to exist. Changes in plans or specifications shall not lie made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />