Laserfiche WebLink
&,?-COT <br /> Burnett County Office of Zoning Administratorv 0 0 <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 0 :—fl <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 C. <br /> Nei .s..........ma.h.►,e....... ............................. .-�..S....C. T4 1&t. ............................... N Po <br /> OWNER (please print) r CONTRACTOR or SURVEYdR or AGENT a m <br /> �5 ...................................... \5 c a I <br /> ADDRESS ... ................................................ <br /> ADDRESS » <br /> m <br /> ........................................................................................... 21 <br /> . . ...... <br /> . . ............................................................................ .... 1 <br /> ADDRESS ADDRESS <br /> ..... .................................... .......... . . ..' `.a.' .......................... ................... . <br /> PHONE PHONES <br /> ........................................................................................... <br /> PLUMBER . .......................................................................................... r <br /> WELL DRILLER <br /> ........................................................................................... O <br /> ADDRESS . .......................................................................................... <br /> ADDRESS <br /> n o <br /> ........................................................................................... <br /> PHONE PHONE <br /> DESCRIPTION 4. Sanitary Facilities: ° o 0 <br /> 1, Work: No. Bathrooms <br /> 2. New Building Details <br /> New euildin Gana Q, <br /> Type of construction: No. Bedrooms .......... <br /> .....1.. <br /> Addition ,,,,,,,,•, .,••, •• Aa.d... , „• Septic Tank Size Gals. .......... <br /> Sanitary N..)�........ .......... <br /> y .......... Size ....'..\....... ft. x .....W..1.... ft. <br /> Filling/Grading .......... Height.g......... Sones ....i.......... 4a. Absorption Field Site: <br /> Moving .......... Area .........6.'dk...... ............... Soil Type .................................... r <br /> n o <br /> Mobile Home .......... Slope .......................................... X� » <br /> Privy .......... 3. Use (describe exactly, 1 -family Pere. Rate ................................... A. 11 ) <br /> Well .......... home,garage, motel, etc.) Dry Well .......... <br /> Subdivision ,,,,,,,,,, Seepage Trench .......... <br /> .................................................... <br /> _ . <br /> Camping Unit ......... Privy .......... <br /> Seepage Bed .......... <br /> ----------------------------------------------- <br /> -------- r ` C : <br /> vs. <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 <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. t N <br /> -------------------------------------- . <br /> _______________ o <br /> _________________ <br /> 5. Lot Size: Fig. A. 6. Location: o <br /> ................ ft. x .............. ft. — ............................... sq. ft. ............................................................................... <br /> ad <br /> N <br /> ;s �i <br /> s�e`O C_X\st C-ill <br /> V' <br /> ( z <br /> - o <br /> r <br /> 2✓e r d <br /> 5aYg1L ° <br /> � 7] (A r c N m z <br /> \ n Q a < c m <br /> 3 e -a �Z C _ n m -V <br /> N b <br /> c O _ j : 4 <br /> J ^0 a <br /> M <br /> .............. ........... / - - <br /> 0 <br /> Signatof Owner or Agent Dat <br /> o C <br /> ure <br /> Remarks ...... .... ..... ................. ... ... ........... . . x 0 <br /> w ' <br /> .................................................................. PR <br /> .. .. .(/� <br /> Inspection Date ....................................... ...... . :. .��2.!��'�2ti..� ... .......... <br /> Zoning Adminygator <br /> NOTE: A preliminary site inspection must be made and to approval granted on all structures involving sanitary faciliti s <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 bulld <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 lie made without approval of the Zoning Adminis Lratot. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />