Laserfiche WebLink
Burnett County Office of Zoning Administr itor �' o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT ;W a <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements o the n <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and <br /> regulations of the State of Wisconsin. �: n <br /> ^ <br /> K. ..R.r1.. .,v.........h��7..C... ..K...Ka.F..F...... ........A.i.h!.R.�e..l�.......L.-.�'.-..t'.. .................... ....... F <br /> OWNER (Dlease print) CONTRACTOR or SURVEYOR or AGENT o <br /> .....RJ.............................................................................. .................................................................................... ....... w <br /> ADDRESS ADDRESS vl <br /> 12.N..N....13.u..('. ,.......�Sr:.i:.....✓``f. ..za.... ..........la.w... v.....ra...�`...TA.a-1-f .�.r............. ....... : 1 �G— <br /> ADDRESS <br /> h / '/ ADDRESS <br /> PHONEf.V...'......0. . ..`.... ..ki..7............................. .PHONE •�` <br /> ...... <br /> PLUMBER WELL DRILLER <br /> ADDRESS ADDRESSn C <br /> ........................................................................................... ................................................................................... ........ O .i <br /> PHONE PHONE Z N � <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> 1. Work: No. Bathrooms I <br /> k 2. New Building Details •••••• e <br /> New Building / Typ of Construction: No. Bedrooms . ........ <br /> Addition - , Septic Tank Size Gals. . ........ E - <br /> Y .......... . `i. �..6. ft. . ........ E <br /> Sanitary Size ..... . .. ft. x ....... <br /> Filling/Grading ......•••. Height............. Stories ..i............ 4a. Absorption Field Site: <br /> Moving Soil Type ........................... ........ <br /> Mobile Home .......... Slope ................................. ........ <br /> Privy .......... 3. Use Idescribe exactly,'1 -family Perc. Rate .......................... ........ � i jam ) <br /> Well home,garage, motel,etc.) Dry Well ( / <br /> ... { <br /> Seepage Trencho <br /> Subtlivlalon • <br /> .......... .... . ............ <br /> Camping Unit Priv . ........ <br /> ...................... <br /> Seepage Bed ..... <br /> ---------------------------------------------------------------------- <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is Iota ed at <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersection. <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o <br /> i <br /> 5. Lo Size: r\.. ft. — ............................... sq. ft. <br /> 6. Location: : <br /> ..�.�.�..... ft. x 11.0. q. ..................................................................... ......... <br /> N O <br /> O � 7 <br /> 7 <br /> O <br /> O_ <br /> o <br /> See �h�o� <br /> T <br /> Z 2 <br /> 0 <br /> d <br /> m <br /> 71 N V N r D W <br /> (p c w m � c a c <br /> n �a < 000 � � m <br /> n m a n y <br /> O N N O i0 ti) <br /> p yr,I <n n <br /> C o C n S <br /> o " m <br /> 91�n .... Om <br /> ature of wner or Agent Date <br /> o : <br /> Remarks m N <br /> w � <br /> N <br /> ................................................................................................................................................................................. ...... : N . . O <br /> : O : � <br /> ............................................................................................................ ................... 1 ...... .. ............................. ...... <br /> Inspection Date $ u�' N T <br /> ....................................... ........ . . . . . -; .mi 'i:s'I/.N .. . . ..... o . O O <br /> Zoning Administra� ��n 0 0 o g <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 app ication 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 be 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 />