Laserfiche WebLink
Burnett County Office of Zoning Administrator o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3 <br /> o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as H <br /> shown herein`. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m C :V <br /> Ordinance, anitation Code,and with all other applicable County Ordinances and the laws and regulatl n of the State of Wisconsin. 3 0. <br /> ^ ............./1... ... ../I....................... ................... .............. .. <br /> �2 µ d o <br /> ............................................... <br /> OWN R (please print) CONTRACTOR or SURVEY R or' <br /> r AGENT o. <br /> �'{ ...... ..1.......�E�� . ...... .. ..`. ............................................................................................ <br /> Ca <br /> ADDRESS » <br /> ./.!+r.�l...l ...t��i..... ......w. .....C.VVV . ..........................................................................I............... <br /> ADDRESS ADDRESS <br /> ................................................................................ <br /> PHONE PHONE <br /> n" ; C <br /> ..................... <br /> PLUMBER WELL DRILLER <br /> . .n✓ L -r ..................... ............................................................................................ O <br /> ADDRESS o <br /> PHONE �� ,r PHONE Z r <br /> 4. Sanitary Facilities: o o 0 <br /> A <br /> 1. Work: �V r i" ;�' Vew Building Details No. Bathrooms ....1..... '`� of <br /> New Br r cNo. Bedrooms <br /> �� tt _� � J type of Construction: i W i <br /> Additlo Septic Tank Size Gals. .......... E� i <br /> 11 <br /> Sanitan raze ...;?:.q... ft. x .....! �...�i t•�t fiy .......... N i <br /> 01 �-- 4a. Absorption Field Site: <br /> Filling/ Leight............. Stories ............... <br /> Moving 4rea .....fQ..c?. .................... Soil Type .................................... r <br /> p o <br /> Mobile Slope .......................................... 3 » <br /> Privy Jse (describe exactly, 1 -family Perc. Rate ................................... <br /> Well tome,garage, motel,etc.) Dry Well .......... <br /> Y r / Seepage Trench <br /> Subdivi: - .......... <br /> ...... ............... <br /> CarlPrivy .......... <br /> ................................................... Seepage Bed <br /> Location of proposed structures and existing structures well, sewage systems, roads etc.,should be sketched in Fig. A. Include road IC„ 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- N a <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING `1 = <br /> P <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o 0 <br /> ---------------------------------------------------------------------- <br /> 5. Lot S e: p Fig. A. 6. Location: <br /> ....1..7. .1.. ft. x ...,5..�... ft. — ..a..3 ..(+..�..C�....... sq.ft. ............................................................................... o3 <br /> r <br /> > N o <br /> o <br /> CI <br /> r. <br /> 0 <br /> o <br /> a Y <br /> m <br /> �Rd o <br /> M <br /> I <br /> ] N r 9 m m Z <br /> M c a d c m <br /> O Hi Q n m _� a E <br /> on C v DmZ <br /> Z o 0 0 ' n R <br /> - - - or 3 <br /> rr <br /> o . <br /> Signature of Owner or Agent Date — <br /> ,/� - m x <br /> Remarks �!d.��....`=..G.'.�::��.`....................................................................................................................... rr� i <br /> E» <br /> ....................J+is 1j�.le as -'S` 1.�..�.fi.................. .... ............................... ......................................... p <br /> .... .... .............. .......... ... . .............. -T <br /> Inspection Date ....: .-.G�.L......... 0. .. �0 ............ N �rsl G10 R <br /> /✓ rt <br /> Zoning Administrator K J <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 be made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />