Laserfiche WebLink
Burnett County Office of Zoning Administrator 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. <br /> o C <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < N � <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use A C <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 0- O <br /> /� O <br /> ..............4h...d........ ............ ............................................................................................ <br /> OWNER (please print) ^-}-- CONTRACTOR or SURVEYOR or AGENT n <br /> ADDRESS ADDRESS <br /> �..fi...... 4.. ....�....... .........................................s ........................................ ................................................... �- <br /> ADDRESS ADDRESS <br /> PHONkPHONE <br /> ...... ....... .............'........................................... .. ........................ .................... . ... ...... ..................... ...... <br /> PLUMBER WELL DRILLER :meq :dam <br /> O <br /> .. . .. . .............................................................................. . . ....................................................................................... _. <br /> ADDRESS ADDRESS \ n o <br /> o 4, Q <br /> PHONE PHONE <br /> DESCRIPTION 4. Sanitary Facilities: 1 ° o ° <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details a° <br /> „v <br /> New Building ,,, Type of No. Bedrooms <br /> struction: <br /> Addition Septic Tank Size Gals. ._....... :� <br /> .......... A '..! ................pp........... <br /> Sanitary ..( Size <br /> Fillingl Grading ,,........ Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area .................................I......... Soil Type ............................. <br /> Mobile Home Slope ........................ ......................... or <br /> i <br /> Pere. Rate ................................... <br /> Privy 3. Use (describe exact) 1 -f�ami ��� ;.(1 <br /> Well home,garage, motel, et�T Dry Well .......... <br /> Subdivision , „ •, <br /> Seepage Trench .......... ?^l <br /> Camping Unit ....I..... .................................................... Privy ,,��yy t/,i� �n <br /> Seepage Bed �..d / .'�� ;i, �', 44 <br /> ---------------------------------------------------------------------- �) ASrn-I-c `C'3 <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched in Fig- A- Include road �• f � G <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- <br /> section, show the intersecting highways and the setbacks required along them and at the intersection- CLEARLY LABEL EXISTING 'p <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> -------------------------------------------- <br /> 5. Lot Size: �al Fig. A. 6. Location: <br /> ...�..P-P... ft. x ......... ft — sq. ft. i 1 <br /> ............................... ............................................................................... <br /> rI <br /> ^. <br /> N 'N 0 <br /> 3 a <br /> � Yr <br /> V � <br /> : S <br /> � m <br /> oo <br /> G Z :o <br /> d <br /> < TW <br /> Cm <br /> < C <br /> Z OO n69 <br /> n <br /> o C a m 3 <br /> m <br /> - / 7 - 9T <br /> ....... ...... oa <br /> . . ....... .... ................... ........ ............ ....... ...........I................ <br /> Signature of 0 r or Agent Date X . . <br /> Remarks ' .` �mj <br /> .... ...... .....�Cc G ...Gly ............. ..... .... . .... ..... ................. ............ .. ........... ................... ... . . ... _ <br /> ` q <br /> ..................G. �.`:.C.-.b.<<.<.�... ..�:.:,�r...h.p.. ............................... ..........�AdministiratOr <br /> ................................. O 'I : <br /> Inspection Date ....I/.�.� ....C:S ...................... i ° 0 8 o N m <br /> . .......... ...... .. . .. .... .' : 8 8 8 8 8 8 y <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 />