Laserfiche WebLink
Burnett County Office of Zoning Administrator M oo <br /> APPLICATION FOR SANITARY - LAND USE - BUILDING PERMIT 3 <br /> o :\ <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> .!�.N-. .................................... ��/'/sJ'.,p/�l.,�,c/. ..... J,rC�{cosar .............................. <br /> OWN R (please print) CON Tifl ACTOR orRVEYOR or AGENT a <br /> 7 y <br /> ...................................... S. .C° ...7 ........... ........ <br /> AD ESS ADDRESS <br /> .. .... �,.......1 ..�.....SY...a....... <br /> ADDRESS ADDRESS <br /> Ajssi <br /> 7��...-.yea'.:-.99. ............................................. ... . . . <br /> PHONEPHONE................................................................................ � . <br /> .......... <br /> ........................................................................................... .WE......LL....D.....RI LL.....ER............................................................. i <br /> PLUMBER <br /> ................ O <br /> ........................................................................................... ............................................................................................ <br /> ADDRESS ADDRESS m 0 <br /> .................................................... .. <br /> n O <br /> PHONE PHONE Z J <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> i <br /> i. Work: 2. New Building Details No. Bathrooms .......... o .� <br /> New Building .......... Type of Construction: No. Bedrooms .......... i <br /> Addition .................................................... Septic Tank Size Gals. .......... < i <br /> .......... <br /> Sanitary ......I... Size .............. ft. x .............. ft. .......... <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> ...............e ................. <br /> Moving .......... Area ........................................... Soil Type r <br /> O <br /> Mobile Home .......... Slope ..............................I........... (' <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Well ....... home,garage, motel, etc.) Dry Well .......... <br /> Subdivision .......... Seepage Trench .......... <br /> .................................................... <br /> Camping Unit .......... Privy .......... <br /> .................................................... <br /> Seepage Bed .......... <br /> --------------------------------------------------------------------- <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 yard dimension and location and setback from all bodies of water. If property is located at a highway inter a <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. o--------------------------------------------------------------------- ' <br /> J <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... sq.ft. ............................................................................... <br /> 0 <br /> o J <br /> tit 1Ro <br /> 1V O <br /> I <br /> ( O <br /> 1� m <br /> t0 <br /> m <br /> CI o� <br /> 7J (nr9 � m 0 <br /> z a <br /> o ° a ' � <br /> o � <br /> ... ............... . ......... ............................... ...�� JSo C <br /> Signat......ure of Ow..ner.. ..or Agent.... Date <br /> X 31 <br /> m <br /> Remarks ......................................................................................................................................................................... mr <br /> n ' <br /> p <br /> Zoning Adminl trator i\� <br /> ... ..... <br /> Inspection Date ....................................... .... 9�2� \ w T <br /> ...... ..... ...........:........ <br /> tli�L� O ,uNi in o ,roi� o rNn m <br /> ................... g K J............. : ' `, 9 9 8 $ o 8 w <br /> 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 riot purchase or install a septic tank, do any plumhing 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 lie made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />