Laserfiche WebLink
ON COMPUTER/SCANNED 1� <br /> Burnett County Office of Zoning Administrator V 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 _ ::53 <br /> 53 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < N <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and <br /> r regulations of the State of Wisconsin. 3 a <br /> --1..G.(:!.. ....... ... ......... .r � G'/.iL.�?bf/.1.� Y. .... ...�.J..uw'.:SQA:??1.................................. [ .. <br /> a <br /> d O <br /> H <br /> .................... <br /> OWNER (plea a pri t) CONTRACTOR or SURVEYOR or AGENT a <br /> �f�l/e hT v Gr/j, Ss! Y3................................ a <br /> ........................................................................................... . . ...................,.......... .. ....... <br /> ADDRESS ADDRESS <br /> ADD ..................................................................... .A........................................................ ........ ......... :w <br /> DDRESS <br /> ................ ................................. <br /> PHONE........ ....................................................................... .PHONE.............................. . <br /> . . . . . ... . .............................................. . .......................................................................................... <br /> PLUMBER WELL DRILLER <br /> O <br /> ................................... ........ ...................................................................................... <br /> ..................... ........................... . <br /> ADDRESS ADDRESS.... mn o <br /> ............... <br /> ........................................................................................... . ........................................................................... <br /> PHONE PHONE Z r <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> Bathrooms <br /> 1. Work: 2. New Building Details No. """"" <br /> New Building .......... Type of Construction: No. Bedrooms .......... r, ; <br /> Addition Septic Tank Size Gals. .......... <br /> ......... < <br /> Sanitary .......... Size .............. ft. x .............. ft. .......... <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: E <br /> MovingArea ........................................... Soil Type ................. r.......... . .Slope ........................ ............. ... <br /> Mobile Home .......... o <br /> i <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... i <br /> Well home,garage, motel,etc.) Dry Well .......... <br /> Subdivision Seepage Trench .......... <br /> Camping Unit .......... .................................................... Privy .......... <br /> Seepage Bed .......... i <br /> ---------------------------------------------------------------------- <br /> Location of proposed structures and existing structures well,sewage systems, roads,etc., should be sketched in Fig. A. Include road Q <br /> setback, side and back yard 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. o <br /> ------------------------ <br /> ---------------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft�— ............................... sq.ft. ............................................................................... <br /> � � N <br /> F- o <br /> Aj <br /> I 1 0 <br /> 0 <br /> if <br /> 1 C Z Z <br /> 0 <br /> C� 1 G <br /> �r <br /> � N v N m 2 <br /> rrn <br /> Z o n �1 <br /> 0 <br /> :W� m <br /> /-..lo.........-'.............. s c <br /> Signature of Owner or Agent Date . jg <br /> X <br /> Remarks ......................................................................................................................................................................... ^� O <br /> m <br /> en <br /> ...................................... ................... ... ' <br /> : <br /> Inspection Date ....:.................................. ..�... .�. .i.... .. ..... <br /> m <br /> Zoning AdnRnistrator ,r✓ E 5 8 8 8 8 8 8 rm/) <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 revoked if misrepresentation of any of the information conveyed here- <br /> with is found to exist. Changes in plans or specifications shall not tie made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />