Laserfiche WebLink
Burnett County Office of Zoning Administrator <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described land i <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of <br /> the ,$ <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws land 3 <br /> regulations of the State of Wisconsin. c <br /> ....... ................................................. .. . ........................... ... - A <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT o <br /> 3...� 5... .H�wN...���u ........................ ........ . ..........................................................................�...... d b0 <br /> ADDRESS ADDRESS <br /> ST...PRuL.......................................5" ., <br /> AD RESS ADDRESS <br /> �..!fS/-3.26.'( `04 <br /> ...... <br /> PH NE PHONE <br /> ........................................................................................... WEL. ..L...D. . .. .ER................................................................11...... <br /> PLUMBER............................................................................ RILL <br /> J <br /> ADDRESS <br /> ADDRESS..................................................................... <br /> O O l/ <br /> y _ <br /> ........................................................... )...... <br /> PHONE PHONE Z <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> 1. Work: 2. New Building Details No. Bathrooms ....... c :G <br /> New Building ..A.., Type of Construction: No. Bedrooms ...j....... <br /> Addition .......... -,,,-„F t /X)• ,,,,,,,••,,,..... Septic Tank Size Gals. ....... <br /> Sanitary Size .2 .1....... ft. x .3.7.*..... ft. 4a. Absorption Field Site: . <br /> Filling/Grading .......... HeightQ.1dc/..... Stories ...I........... <br /> Moving .......... Area 15<?... �TSoil Type .................... <br /> .. ............... ......... <br /> Mobile Home Slope ...............................I............. i r <br /> .......... <br /> i <br /> Privy .......... 3. Use (describe exactly,*1 -family Perc. Rate ................................... <br /> Well home,garage,motel, etc.) <br /> Dry Well ......... <br /> .......... Z <br /> Seepage Trench ; <br /> Subdivision .......... ...... i ... o . <br /> Priv ... i <br /> Camping Unit .......... ...... ............................................ y i....... <br /> Seepage Bed ...I....... - <br /> ----------------------------------------------------------------------- <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fi A. :^ <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is located at --� ? <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersect on. `— <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. .. 1 0 <br /> ------------------------------------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: <br /> 1.�...... ft. kL7./'!5a_ ft�'�. /�>3_S.Q ........ sq.ft. .......................................................................IL...... <br /> .r141, 2Sr <br /> 1 0 <br /> j <br /> GP f <br /> 31r 3p �-2 - 71 p7D �z <br /> o <br /> Ix <br /> 1! 011/ill 30 <br /> � <br /> F(et�l �Exrsrs) Barg <br /> s / i2r Waste <br /> -7r 1Ex157-3 mem Dwao � <br /> 0 �»Q < > > � � � m <br /> > 3 <br /> O 3 `� O u) m <br /> 2 rn <br /> on 0 <br /> n : o <br /> . .r. ... ...... > . <br /> gnature Owner or Agent Date <br /> o , <br /> y . <br /> Remarks .................................................................................................................................................................... ... Tm ..- <br /> m <br /> ................................................................ <br /> 0 <br /> ....................................................................................................... .... ................. e <br /> Inspection Date N N No o u m <br /> pe ....................................... ..... .........9. . <br /> Zonin Admin ator 88888 8 <br /> NOTE: A preliminary site inspection must be made and site app val granted on all structures involving sanitary fa ilities before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this applation before a permit will <br /> be issued. Do not purchase or install a septic tank, do any plumbing or start any building until a permit has been issued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or specifications shall not be <br /> made without approval of the Zoning Administrator, <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APAROVED. <br />