Laserfiche WebLink
1 <br /> Burnett County Office of Zoning Administrator d -0 -� 1 Z <br /> CD 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT h' <br /> o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as v 2%40 <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 :O <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3. 0 <br /> C '•© O3 <br /> '�. .......70-e.M/F:S............................. ............. e..t. .............................................................. y 7� <br /> OWNER (please p nt) CONTRACTOR or SURVEYOR or AGENT a <br /> ADDRESS ADDRESS e�l1 <br /> ADDRESS ADDRESS <br /> ............................ ............................................................................... tiro <br /> PHONE PHONE ti <br /> PLUMBER WELL DRILLER <br /> ........... <br /> ADDRESS ADDRESS <br /> 0 o <br /> . . . ... .......... .. <br /> ............ o' r+ <br /> PHONE PHONE. r� Z H r <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: . / 2. New Building Details No. Bathrooms :::::::::: ? o <br /> New Building Ty�p�e�of Co stru ion: No. Bedrooms <br /> Addition ....V:0.4.....`t!yv►.M t !^�j „ Septic Tank Size Gals. <br /> Sanitary .......... Size ...AP..... ft. x ..3. .. ft. ......• 1 <br /> Filling .......... Height............. Stories ...1.......... 4a. Absorption Field Site: <br /> Moving .......... Area .18.� Soil Type .................................... r- <br /> ° <br /> Grading lope .......................................... cS �« <br /> Mobile Home Perc. Rate ................................... t <br /> .......... 3. Use (describe exactly, 1 family :p <br /> Privy .......... home,garage, motel, etc.) Dry Well w <br /> Well Q Seepage Trench <br /> Y........................... <br /> �....... Privy ti Subdivision •..•,.•,•. Y <br /> ..............................................." . <br /> Seepage Bed <br /> ---------------------------------------------------------------------- cy C <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- _CL <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING ^ <br /> \.i H <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. t <br /> --------------O------------------------------- 0 �'----------------------- <br /> 5. L t Si e: Fig. A. 6. Location: <br /> .... ft. x .... ft. — ............................... sq.ft. ............................................................................... <br /> Ye-1/0 w L,K <br /> h <br /> N o. <br /> O 0 <br /> tj <br /> t 1 <br /> CD <br /> CD <br /> :Q <br /> o <br /> 1 Pro P e <br /> CD <br /> CD <br /> C <br /> I17 <br /> CD <br /> 10 p <br /> ...................................... , o . . . . . <br /> Signaturv��nt � Date <br /> X 70 <br /> Remarks -n m <br /> m <br /> u <br /> .......................................................................................................... ............................ .............................................. <br /> Inspection Date �'? ..�.. o 0 0 o m <br /> N <br /> ....... I�: 00000 m <br /> ZoningAdmi istrator' 0 0 0 C 0 cn <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 /> :his application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build- <br /> ng until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> Nith 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 />