Laserfiche WebLink
CMZ 6V22r. <br /> Burnett County Office of Zoning Administr itor �' c <br /> APPLICATION FOR SANITARY - LAND USE - BUILDING PERMIT m 3, <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work describe and <br /> 0 <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements o the .$ c <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the law and 3 <br /> re u tions of the State o Isc nsin. <br /> 9 a <br /> t Ih l r 2 " � <br /> .... . .•.b<.y.... .............v ��. .V.,...u.............. .................................................................................... ....... <br /> n <br /> OW�N€q,,(Please Print) CONTRACTOR or SURVEYOR ar AGENT � � <br /> ......................... . .........{.................................................. .................................................................................... ....... e <br /> ADDRESS ADDRESS � •� :�. �\ <br /> ..................� <br /> .............................................. ................................. LADDRESS �zi V <br /> 'd, <br /> . I <br /> ........................................................................................... .P..HO..... ...NE......................................................................... ....... <br /> PHONE <br /> ........................... .. <br /> .. ............................................................ <br /> . ......... .... ............................................................ ........ � <br /> PLUMBER WEL... L DRILLER.. .... ;lam <br /> o <br /> ADDRESS ADDRESS <br /> n 0 <br /> n o s- <br /> `` . ................................................................................... . . . . ........................................................................... ........ 0 » <br /> PHONE PHONEZ n rC-@ <br /> DESCRIPTION 4. Sanitary Facilities: ° o o %6 <br /> '1. Work: No. Bathrooms <br /> v : <br /> 2. New Building Details • ••••"" K:-_� o :� <br /> New Building No. Bedrooms <br /> Type of nstruction: '•"' <br /> • <br /> Addition ,,,,,,,,,,,,,,, Septic Tank Size Gals. ..... <br /> t <br /> Sanitary X Size .............. ft. x ............., ft. . ........ <br /> Filling/Grading .✓.�.. 4a. Absorption Field Site: ' <br /> ,.... Height............. Stories ........... ... � � '• <br /> 9 <br /> Moving .......... Area ........................................... Soil Type ........................... ........ a i <br /> :T. <br /> Mobile Home .......... Slope ................... ............. ........ � .. <br /> m <br /> Privy ..,,,,,,,, 3. Use (describe exactly, 1 -family Perc. Rate .......................... ........ <br /> Well .......... home,garage, motel,etc.) Dry Well ..... <br /> Seepage Trench o <br /> .Subdivision ......... .................................................... <br /> Camping UnitPrivy . ........ A <br /> Seepage Bed . ....... � <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketchedin F . A. c <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is loc ed at4- <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the interse ion. <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. to <br /> _ ___ -------------------------------------- -- :C) i iL1 <br /> r lC. <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — sq.ft. <br /> ............................... ..................................................................... ......... ` :Q <br /> 3 O 0 }' <br /> VFZ <br /> 0 <br /> d <br /> m <br /> m ri m w 0c� cm <br /> 0 H a < 7 0 - - m <br /> m_ mci < am naS <br /> R1Q oS< <br /> N O b m <br /> Z o .2 D 1 <br /> M-A <br /> c _ a A <br /> 9 20 : 0 <br /> .. l m <br /> . ... .. ........................................................ .....!................................ a O <br /> 9 <br /> Signature f caner or Agent Date g <br /> l C. ..� <br /> Remarks <br /> /.�....��../�/�Z_ ../`./�...�...`.../............................................................................................................ ...... � - : : a <br /> ........�Y Y........ -.:.^-'1/J......�J���LO I"% 'j�.:....-...../..... ............................................................................... . <br /> .........�/..... �..... /. ... ..r.4F.. �'.?::............ ............... .......................................... ... I � <br /> X `1.._.....2'!:. ... . ..1.(. �. .�.ilh:::. . ('V.1.. ......... .... <br /> tn O O tNT M <br /> Inspection Date .. ...... ............. m <br /> ........ . ..9 . .. .... <br /> M <br /> Zonin Administr or S 8 S S S 8 <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary f cilities before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this application 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 i n 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 AF PROVED. <br />