Laserfiche WebLink
Burnett County Office of Zoning Administrator �' e <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT ;Z V <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 of the oXD <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and U <br /> regulations of the St to of Wisconsin. 3. <br /> ........i2.................. . .......................................................................................... a <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT <br /> .. bh <br /> �,�"...�:...... .N�......................... . .......................................................................................... <br /> D ESS ADDRESS •m <br /> A ....� A <br /> ...... ............... ............................................................................................ . <br /> AD RESS ADDRESS <br /> .....lr_�Z.-` ' ..:.�Za.................................... �o . �� <br /> PHONEPHONE................................................................................ .7— <br /> ........................................................................................... r n <br /> PLUMBER . . ..................................................................................... <br /> WELL DRILLER <br /> . . . .........................................—,................................... .ADDD-6' .RESS S-S- ................................................. —..................... .a <br /> ADDRESS <br /> 0 � <br /> PHONE................ <br /> ................... <br /> ..................... <br /> .................. <br /> —... <br /> . .... .....................................................—............................ <br /> PHON.. E Z v. r <br /> DESCRIPTION 4. Sanitary Facilities: P o <br /> 1. Work: No. Bathrooms 'a <br /> 2. New Building Details .•..•.••-- <br /> Hew BuildingNo. Bedrooms ° <br /> .. ....... Type of Construction: ........•. ' $ <br /> Addition Septic Tank Size Gals. °y <br /> ................................................. .. .......... <br /> Sanitary .......... Size .............. ft. x .............. ft. .......... <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area Soil Type .................................... r <br /> Mobile Home ........ . Slope .......................................... <br /> o <br /> y <br /> Privy Perc. Rate ................................... <br /> .......... 3. Use (describe exactly,'1 -family <br /> n <br /> Well .......... home,garage, motel,etc.) Dry Well .......... i <br /> Subdivision .,, Seepage TrenchZ i <br /> ................................... ................ .......... <br /> Camping Unit Privy .......... <br /> .................................................... Seepage Bed Lj-- i <br /> ______________________________________________________________________ t .y <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 backyard 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 intersection. <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> _______________________________________ t <br /> ° <br /> 5. Lot Size: <br /> Fig. A. 6. Location: : O <br /> ................ ft. x .............. ft. — ............................. sq. ft. 9ji <br /> . ............................................................................. .ta <br /> Moi <br /> Co r) l,( 1) -1-- l p. <br /> 7-0 <br /> 0 <br /> 0 <br /> D <br /> m EAI <br /> ° <br /> m <br /> 7 <br /> b <br /> m <br /> :u (nmcnr Dm da -0 <br /> n fAa < > > n c S. m <br /> T. - C nay <br /> a C 0 <br /> � a `z D� i <br /> o n S <br /> 0 2 » m <br /> on <br /> = : 0 <br /> x n a <br /> .......................................................................... ...................................... ° m <br /> Signature of Owner o Agent Date o : O <br /> Remarks <br /> See. �re�l.azc�...........�.�:..�s.1a.a5o.,...,�. �,....�3�..�- ......................... <br /> �. <br /> o : <br /> g : 8 <br /> Inspection Date ....................................... .. .... . . . ....71.�!r.G.(, N u, o m <br /> . ......... <br /> Zoning Adminis ford g Ek" F g (A <br /> NOTE: A preliminary site inspection must be made and site appy al granted on all structures involving sanitary facilities 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 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 APPROVED. <br />