Laserfiche WebLink
Burnett County Office of Zoning Administrator C _ o 0 <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 H n <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m c <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 CL <br /> Q <br /> ............... ............................ ............. . . y <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT M .` CD <br /> .......NJ... <br /> ADDRESS ADDRESS , <br /> !..T . .!C'. ........yV.t. .c................................. ......................................................................................... <br /> ADDRESS ADDRESS <br /> ....................................................... ......................................................................................... <br /> PHONE PHONE :D <br /> ............................................................................................ '(Z <br /> PLUMBER WELL DRILLER <br /> 0 <br /> .......... �. <br /> ADDRESS ADDRESS <br /> 0 o <br /> PHONE PHONE rt <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> 1. Work: 2. New Building Details No. Bathrooms :, <br /> New Building .......... Type of Construction: No. Bedrooms <br /> o <br /> Septic Tank Size Gals. CD <br /> Addition .......... � <br /> Sanitary Size ft.x ft. ......•••• <br /> .............. .............. . . . . <br /> Filling .......... Height............. Stories ............... 4a. Absorption Field Site: i <br /> Moving Soil Type .................................... <br /> .......... Area ........................................... <br /> Grading Slope <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 .......... �R N:?�...�f`t��/2�� �NT Privy .......... O <br /> Seepage Bed .......... W <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- o 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. <br /> O <br /> ---------------------------------------------------------------------- C <br /> a Lot Size: ,5...... Fig. A. 6. Location................................................................. <br /> p � <br /> ft. x .............. ft. — Q �l�+G s ft. i <br /> d � J <br /> N <br /> Cn <br /> r+ <br /> a{ 7 <br /> CD <br /> 1\ <br /> O .tJ <br /> ° D <br /> CD <br /> i CD C <br /> _ • 0) 2. Cpd� CDCNaa -< i * <br /> 0 -0 <br /> 6NH gm <br /> oz 0 3 <br /> i1�. U' `a <br /> : V�o � <br /> 9 rs- �_3 <br /> .......... ' "1� p <br /> ........ ...................................... :°Q� <br /> signature of Owner or Agent i��k`?l Date ° ' C <br /> 9 <br /> X <br /> 3emarks -n : ? m <br /> C 0 <br /> ....................................................................................................................................................................................... — <br /> ........................................................................................................ - o <br /> : \e: <br /> nspection Date ....................................... G�iif.D/ �........................... : : 6 6 0 0 o c`�'r, m <br /> .. � ................ 000000m <br /> Zoning Ad istrat0 o 0 0 0 0 o v� <br /> OTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> afore construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> its 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 />