Laserfiche WebLink
Burnett County Office of Zoning Administrator o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 4 y <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and loc ted as < N <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Lad Use m m j <br /> Ordinance, Sanitation Code, and yvith all other applicable County Ordinagces and the laws and regulations of the State of Wis onsin. 3 a <br /> ...................... ..Wa... .... t'... �..�..q{Ia. ... N _ o <br /> OW (pie se print) C TRR r RVEVOR or AG EfUT a <br /> M <br /> .....�.....�...... ....I,.... ............................. ...1 oX.... .................................. ....... .......... ; <br /> /� gyp/• �/ �//�� �j/• lr ((y`y� i <br /> AD.fWrl:.:... 'I�.................... AD RE SV1..p...W.W.�..... `c'...!.�.1......... .......... <br /> it <br /> ADDRESS ADDRESS <br /> ........................................................................................... .....ONE............................................................................ .......... <br /> PHONE. ............................................................................... PH <br /> PLUMBER WELL DRILLER <br /> ADDRESS............................................................................ . .............................................................. ....... <br /> ADDRESS +. O <br /> ...... .......... j <br /> ........................................................................................... ..... ................................................................. ». <br /> PHONE PHONE..... Z w, r <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details o <br /> New Building ....,,,... Type of Construction: No. Bedrooms .......... a <br /> Septic Tank Size Gals. .......... <br /> Sanitary .......... Size .............. ft. x ft. <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area ..................................... ..... Soil Type ..................................... <br /> Mobile Home Slope .............................. ..... ... <br /> .... . . i ro— <br /> ., <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Well ,,.... home,garage, motel, etc.) Dry Well .......... i <br /> Subdivision Seepage Trench .......... <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. Inclu e road rT Q <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property Is located at a highw y inter- Xl a <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EX STING N <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. i o <br /> ---------------------------------- ------------------------------- --- <br /> 5. Lot Size: Fig. A. 6. Location: Q <br /> ................ ft. x .............. ft. . ............................... sq.ft. .......... j <br /> .................................................................. . ` <br /> IN O <br /> o <br /> � 1 <br /> Yo) . <br /> 0 <br /> 59 <br /> z <br /> o . <br /> d < N c N <br /> m a � < <br /> Z n <br /> o : $ _ 7 <br /> b <br /> n <br /> .................................. 'A—g'en*t.............................. ...................................... o C <br /> Signature of Owner or Agent Date <br /> X 7 <br /> Remarks ............................................................................................................................................................... ......... T n <br /> „ C <br /> va <br /> ".... ........... ................. ......... <br /> r <br /> Inspection Date ....................................... ........ ........:..::..........:............. � <br /> .. r —.... ........ u v, o u, o is n <br /> Zoning Administrator <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures Involving sanitary faellitwu <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolatic n test must be attached to <br /> this application before a permit will he issued. Do not purchase or Install a septic tank, do any p umbing or start any bUlId <br /> Ing until a permit has been issued. A permit may be revoked If misrepresentation of any of the formation conveyed heru <br /> with is found to exist. Changes in plans or specifications shall not be made without approval of the Zoning Arlm inistratoi. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />