Laserfiche WebLink
e Cl Ce' ), <br /> Burnett County Office of Zoning Administrator 0 o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT =« B * • <br /> o <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as v, -" <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 \ <br /> Ordinance, Sanitation(Code,and with all other applicable County Jh, <br /> ces�anndd the laws and regulations of the State of Wisconsin. 3 0 <br /> Leetliy P a <br /> y G <br /> NER (please print) CONTRAFTO or SURVEYO o�NT m 3 <br /> al/ 6-Kri 3 a : .''( <br /> ADDRESS ADDRESS ' !?4.) '4,4: 1 : <br /> CD <br /> ADDRESS ADDRESS ‘'N.) fi <br /> PHONE PHONE 1 <br /> PLUMBER WELL DRILLER (1 <br /> 0 <br /> ADDRESS ADDRESS C <br /> 0 <br /> o ,� <br /> PHONE PHONE Z N r <br /> DESCRIPTION 4. Sanitary Facilities: . o 0 <br /> 1. Work: 2. New Building Details No. Bathrooms o <br /> New Building Type of Construction: No. Bedrooms 0 `a <br /> Addition Septic Tank Size Gals. <br /> Sanitary Size ft. x ft. <br /> Filling/Grading Height Stories 4a. Absorption Field Site: <br /> Moving Area Soil Type o <br /> Mobile Home Slope l-+ <br /> Privy 3. Use (describe exactly, 1 -family Perc. Rate <br /> Well home,garage, motel, etc.) Dry Well <br /> Subdivision ,� Seepage Trench <br /> Camping Unit Privy <br /> Seepage Bed <br /> U . <br /> Location of proposed structures and existing structures,well, sewage systems, roads,etc., should be sketched in Fig. A. Include road c <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- _c_ <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. N <br /> O• <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ft. x ft. — sq.ft. <br /> 0 <br /> e , a 57)3 --;_-__- ---c---:'�J I' .�' . J cn <br /> o = <br /> / --' c .-,---) i,T;),,\ 1 ( t- <br /> CD <br /> I It 0 <br /> .� o <br /> I ; i �, — <br /> -i f . J 1 �► <br /> z <br /> , - 0 <br /> Do <br /> 5) <br /> 0 <br /> co <br /> r` `1 T __r L.. <br /> _ of%' j' °D <br /> r' ° <br /> -i x �m � *2m W g <br /> C m1 <br /> o. <br /> Q (= v <br /> OZ 0 7 G 3 <br /> g : <br /> 0\o <br /> MI <br /> Wm m <br /> 7 // 7 / °CD <br /> s c <br /> Signature of Owner or Agent Date ' <br /> X 33 <br /> Remarks "C m <br /> c7.1 <br /> CD <br /> m <br /> Inspection Date - iY4 , Uo. o cn o 0 o N m <br /> Zoning Ad inistrator'CV \ 00 •0 •0 •000 <br /> TOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> efore construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> his application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build- <br /> ig until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> rith 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 />