Laserfiche WebLink
Burnett County Office of Zoning Administrator W --I 0 <br /> APPLICAT40N FOR SANITARY — LAND USE — BUILDING PERMIT d 3. o <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as < m -^ :eV�\ <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 `N <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 M i �. <br /> Bre.:t..W.eKAI'Iwd..................................................... ............................................................................................ <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT n <br /> ......9.00...12.th..St........B 1dwiii,..W.1....540.02......... . . ...... . ............................................................................... <br /> ADDRESS ADDRESS <br /> ........................................................................................... .AD.. DRESS.................................................................................... Al <br /> ..... :[ <br /> ADDRESS C` <br /> ................. ......................................................................... .....................................................................I...................... i <br /> PHONE PHONE <br /> .....P?Q.Pkld..Da-.ia1s..................................................... t y' <br /> ............................................................................................ <br /> PLUMBER WELL DRILLER <br /> dire..1.f..L7I.....5"7.2................................................. ............................................................................................ <br /> ADS ADDRE S �� • v <br /> �+�6 2333 or 349-5364 W 0 o. ......v . <br /> ..... ............................. <br /> PHONE PHONE Z " r S <br /> DESCRIPTION 4. Sanitary Facilities: ° 0 ° ' <br /> 1. Work: 2. New Building Details No. Bathrooms ....1 \ o ~ <br /> New Building .......... Type of Construction: No. Bedrooms <br /> Addition ........., Septic Tank Size Gals. .......... ;(v, <br /> tv <br /> Sanitary ...y.... Size . . ft. x ft. .......... <br /> Filling .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area Soil Type .................................... k1Nr i <br /> Grading Slope .......................................... <br /> Mobile Home .......... 3. Use (describe exactly, 1 -family Pero. Rate ................................... <br /> Privy .......... home,garage, motel, etc.) Dry Well .......... <br /> Well ..,....... Seepage Trench 3 <br /> ......s.i.ngle...fano.ly...aab.i n tj� <br /> Subdivision Privy <br /> .................................................. Y. Hound.......... <br /> ------- -- — ----------------------- Seepage Bed-------- yj <br /> N \ <br /> Location of proposed structures and existing structures,well,sewage systems, roads,etc., should be sketched in Fig. A. Include road <br /> setback, side and back property is located at a highway inter- � <br /> yard dimension and location and setback from all bodies of water. If <<��} <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING so <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. I 0 <br /> ---------------------------------------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: j <br /> ................ ft. x .............. ft. — ............................... sq.ft. ............................................................................... I <br /> � N <br /> n <br /> IN 0 <br /> :, <br /> )I - <br /> \ ) :i <br /> Z <br /> cnmv * w <br /> V ° <br /> Z 0 0' tD _ '�° 70 <br /> o — <br /> ..................... ........................................ ...................................... o ' i C <br /> Signature of Owner or Agent Date <br /> X <br /> Remarks ......................................................................................................................................................................... <br /> m <br /> m <br /> n <br /> Inspection Date ....................................... 0 0.cNn Im <br /> Zoning Administratod 0 0 0 0 0 0 0 <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 />