Laserfiche WebLink
Burnett 6unty Office of Zoning Administrator v - o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT ' . <br /> o : <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as .< H <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use c <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the Stateof Wisconsin. 3 CD <br /> 'Or <br /> '.. .......... ........ ID <br /> ............ ..................... . . . . . ...... ... ..c.. ... <br /> OWNER (please print) CONTRACTOR or SURVEYOR oWAGENT a <br /> ............. ..... .............. ...................:............... ............................................................................................ <br /> ADD& ADDRESS <br /> ............... Y. ......... ........................................................................... <br /> ADDRESS 5p� ADDRESS <br /> ................................................................................ :gyp <br /> PHC}?Q;f ` PHONE <br /> (.... ........... ..... .........".................................................. ............................................................................................ <br /> PLUMBER WELL DRILLER <br /> .......... :� O <br /> ADDRESS ADDRESS •.� o c <br /> c < " <br /> . ................................................................................... ............................................................................................ z O <br /> PHONE PHONE <br /> r <br /> is <br /> DESCRIPTION 4. Sanitary Facilities: o 0 o .� <br /> 1. Work: tee' 2. New Building Details No. Bathrooms �:vl o <br /> No. Bedrooms �--- :3�3Z <br /> New Building '.. Type o onstruction: " <br /> Septic Tank Size Gals. <br /> Addition ' ......... .......................... ......... <br /> Sanitary ....,..... Size ... .�Q.. ft. x ............. ft. <br /> 4a. Absorption Field Site: <br /> Filling ......,... Height............. Stories ............... p <br /> Moving Soil Type .................................... o <br /> ......... Area ........................................... <br /> GradingSlope .......................................... <br /> Mobile Home 3. Use (describe exac 1 family <br /> Perc. Rate ................................... <br /> Privy home,garage, motel, ete� Dry Well .......... t <br /> Seepage Trench <br /> Well <br /> Subdivision Privy .......... \ <br /> .........................................I.......... Seepage Bed <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. Include road '3 c 3TJ <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 �t <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> -- `J <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... sq.ft. ............................................................................... <br /> co <br /> i 0 <br /> o h <br /> _o i< <br /> I � N <br /> 1 rt <br /> • � S <br /> \ <br /> L : <br /> T <br /> CD zZ <br /> a: <br /> c <br /> CD <br /> m <br /> �o • cnr.� �. W <br /> c v <br /> ID, NOS.. Q� <br /> d <br /> o cn < C . — � <br /> Z oo'o : <br /> o —1 <br /> CD M <br /> _ .............. ................... 0 p <br /> Signature of/fO}wr/er o gent Date — <br /> Remarks ............... .......................................................... .............................................................................................. <br /> � <br /> w <br /> 44 <br /> . ................................................. <br /> 41 <br /> Inspection Date c o 0 0 0bbb o cNn <br /> Zonin Aclknistra6tr 000 000 <br /> VOTE: 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 />