1983/07/22 - SANITARY - SAN - New HT - 10914

Home Browse Search

Burnett County Office of Zoning Administrator v CD o APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT . TO SHE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use CID Ordinance, Sanitation Code, and with all other ;4pli, ablle County Ordinances and the laws and regulations of the St to of Wisconsin. 3 0- t� a OWNER (please print) ��j� f,, CON T OR or SURVEYOR or AGENT a v CD Q � ........ ..... -a.�!" .. .w............... .................................................................................. ADEIR'ESS ADDRESS i ADDRESS ADDRESS :N ............ .: PHONE PHONE �•, •rl •4y ............................................ ............................. ..................................................................................... :N PLUMB , I WELL DRILLER .................... ........................................................................... o .ADDR ADDRESS ;°q ° i .1 .�..... . ...,n ...........,Y�z� ............................................................................................ PHONE PHONE z y r DESCRIPTION 4. Sanitary Facilities: ° 0 o 0 1. Work: 2. New Building Details No. Bathrooms �. o New Building ,,� Type of Construction: No. Bedrooms . A" M •,� <' Addition Septic Tank Size Gals �. Sanitary • Size .............. ft. x .............. ft. Filling .......... Height............. Stories ............... 4a. Absorption Field Site: Moving Area Soil Type .................................... : r S .......................................... o GradingSlope .......................................... 5 Mobile Home ,......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... Privy home,garage, motel, etc.) Dry Well i Well Seepage Trench .......... .......... .................................................... Subdivision Privy .......... .......... .................................................... Seepage Bed .......... ---- ------- 01 Location of proposed structures and existing structures,well,sewage systems, roads,etc., should be sketched in Fig. A. Include road a setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- o section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING < STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. y o' ----- --- ----------------------------------- 5. Lot Size: Fig. A. 6. Location: ................ ft. x .............. ft. — ............................... sq.ft. ............................................................................... C m o t 0 D G1 7 CD Z O v 7 CD +f(D U) U)up z c m m c`Di O C• CD T. N D_ O_ oy.c . ID � om z o o — o � `D "' ............!'.. o p Signature wner or gent Date — X 70 Remar 1(:.C....lr .... -n vm m .......... ' G.��1.. '.,=:: 'Gfr�........................ . ................................................ .......................... 7 ' oo � m Inspection Date . ,l ... � ..... .AAVnistra�' p . .. ...... .. ...... ...... �.�.................... n: o o O m oni r . . o 0 0 o N VOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary face i t i e s before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to this application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build- ng until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- with is found to exist. Changes in plans or specifications shall not he made without approval of the Zoning Administrator. SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED.