Laserfiche WebLink
Burnett County SCANNED Office of Zoning Administrator o 0 <br /> APPI-AICATION 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 '< N � <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use � \ <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 C- <br /> CD <br /> . .�1��.... ......./`14... .. ..r�............................... N <br /> OWN!f (.please pp(int) CONTRACTOR or SURVEYOR or AGENT \ 1 <br /> ! .►"...ft... - .X..!!if.. ./�.......................... �3 <br /> ADDRESS ADDRESS <br /> P..!'0......w y......5.` . °.�............. ............................................................................................ <br /> ADDRE S ADDRESS : <br /> ............................................................................. PHO NE ............................................................................... <br /> PHONE <br /> ............................... x� <br /> PLUMBE �^ 0 WELL DRILLER <br /> . /. . .. S'M{.I�i.......s'. er.Q.Y.,q..Y�.......w.,Z...... ............................................................................................ o <br /> ADDRESS ADDRESS CDo <br /> + < <br /> ................................................................................ ............................................................................................ z o <br /> PHONE PHONE r <br /> DESCRIPTION 4. Sanitary Facilities: ° 0 ° <br /> 1. Work: No. Bathrooms : <br /> 2. New Building Details "'�"" o <br /> New Building .......... Type of Construction: No. Bedrooms ID <br /> Addition Septic Tank Size Gals. .1.�� :� <br /> Sanitary Size .............. ft. x .............. ft. .......... <br /> Filling .......,,. Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving Soil Type .................................... o <br /> ...I..... Area ........................................... <br /> Grading Slope ...................U..`��.�....... <br /> Mobile Home .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Privy .......... home,garage, motel, etc.) Dry Well <br /> Well Seepage Trench •••....••• <br /> .................................................... <br /> Subdivision Privy .......... <br /> .......... ............................... <br /> Seepage Bed .......... <br /> —————————————————————————————————————————————————————————————————————— I Cn , <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched in Fig. A. Include road 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- <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING l 1,% �<—• <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o A <br /> ---------------------------------- ------ ----------------------- 3 ) :� <br /> 5. Lot Size: Fig. A. 6. Location: ( 1� <br /> ................ ft. x .............. ft. — sq.ft. <br /> Cn <br /> cn <br /> N O <br /> o 7 <br /> 3 <br /> 0 <br /> N <br /> • .1 ,1 J <br /> V' N <br /> V <br /> o <br /> n> <br /> cc <br /> co <br /> Cn co Z <br /> o- n < c m <br /> to < C : <br /> h o N . :E M <br /> z o o m <br /> o — <br /> o <br /> 0 <br /> huls <br /> Dm <br /> . ....... . nJ.. is- . . ................ .....sgnature o Owner or Agent e '� `• — <br /> // X <br /> Remarks 1..�. C` Z'` t `� - M <br /> : ..G.............................................................................................................................................. CD <br /> :�: m <br /> CD <br /> � r � .>.�. . arc:i�./t-'.......................................................::.................................................... o <br /> Inspection Date yQ. .... ..... ....C.J ............ Ic o 0 0 o m <br /> p .....1..: .................... g .. o00 oom <br /> Zonin Admi iffstrator ' 0 0 0 0 o 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 />