Laserfiche WebLink
Burnett County Office of Zoning Administrator v - o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <br /> 3 <br /> ''TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as H 0 <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use co c { <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. a -v V <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT coo CD <br /> 4DDRESS ADDRESS� 11 / / C <br /> CD <br /> . (l '✓u4� 42.' Svf''93 — \ <br /> ADDRESS ADDRESS .,'0 <br /> 'HONE PHONE <br /> 'LUMBER WELL DRILLER <br /> v <br /> 4DDRESS ADDRESS CD 0 <br /> 0 <br /> 'HONE PHONE 0 '- <br /> z N <br /> DESCRIPTION <br /> 4. Sanitary Facilities: P "6 ° <br /> 1. Work: 2. New Building Details No. Bathrooms o <br /> New Building Type of Construction: No. Bedrooms CD <br /> o <br /> Addition Septic Tank Size Gals. <br /> Sanitary Size ft. x ft. <br /> Filling Height Stories 4a. Absorption Field Site: <br /> Moving Area Soil Type r- <br /> Grading Slope >1- ° <br /> Mobile Home 3. Use (describe exactly, 1 -family Perc. Rate , <br /> Privy home,garage, motel, etc.) Dry Well <br /> Well Seepage Trench <br /> Subdivision e/ Privy <br /> Seepage Bed <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched in Fig. A. Include road i t. <br /> 6 <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- i 1 0_ <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. ' <br /> 3 <br /> 5. Lot Size: Fig. A. 6. Location: g <br /> ft. x ft. - sq.ft. ' <br /> e 57)3 , <br /> cp <br /> ,52,Z4-1 --, <br /> �y� �45 <br /> o <br /> 0 <br /> -5. <br /> CD <br /> 0 <br /> DO <br /> CO <br /> 7 <br /> ca <br /> m <br /> DOCcr 7 * �co Z <br /> cr, n) _. n n' C co <br /> n7 < - <br /> coo_,< - 7,' - <br /> a d 5. 0 17 <br /> 0 < g m <br /> Zc° : : fD 77 <br /> 0 = g <br /> '1/4)0 <br /> 0 70 <br /> signature of Owner or Agent Date ° C <br /> X DO <br /> Remarks ,i m <br /> CD v <br /> kfy a. <br /> nspection Date9a,,,,,kiafx? ..yZat o00 0oCNDm <br /> Zonin Adminst lr' 000000fm/) <br /> 9 J <br /> OTE: 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 /> pis 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 /> ith 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 />