Laserfiche WebLink
Burnett County Office of Zoning Administrator C - Z <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> cTO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land UseCDc <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. I a �' <br /> _. <br /> .I.?'1...°e. ........:63.a.�''4.,�1�.�5'.��ir....... _ <br /> ............................................... . . ti d O <br /> O ER (Please print) ... .. . .................................. y '� � <br /> CONTRACTOR or SURVEYOR or AGENT �,\ D_, <br /> CL <br /> � ............ .. ... . . ........................................................................................ <br /> ADDRESS <br /> .. . . . . .. <br /> ADDRESSa \. .......................................................................................... <br /> // . �9 <br /> ADDRESS <br /> PHONE ............................................................................................ <br /> PHONE <br /> PLUMBER .......... ,4 <br /> WELL DRILLER <br /> ADDR <br /> . ...... . .ESS.............................................................................. <br /> ADDRESS � O <br /> n o c� <br /> PHONE PHONE <br /> ............ o <br /> DESCRIPTION Z r <br /> 4. Sanitary Facilities: o 0 <br /> 1. Work: 2. New Building Details No. Bathrooms <br /> ......... <br /> New Building Type of Construction: No. Bedrooms o ' <br /> CD <br /> Addition Septic Tank Size Gals. <br /> .......... ................................................. .. ......... <br /> Sanitary Size .............. ft. x .............. ft. ..........` : <br /> Filling Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area .................................... Soil Type ........................................... <br /> radin9 <br /> Slope .......................................... ° <br /> M e Home .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Priv .. . ..... home,garage, motel, etc.) Dry Well <br /> .................................................... <br /> Seepage Trench <br /> Subdivision <br /> .......... Privy ......... <br /> ------------------------------------------------------------------ <br /> Seepage Bed .......... :�►� :� <br /> Location of proposed structures and existing structures well, sewage systems, roads etc., should be sketched in Fig. A. Include road :X <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 <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. y' <br /> -------------------------------------- <br /> o' <br /> 5. Lot Size: Fig. A. 6. Location: .� <br /> � F <br /> ft. x .............. ft. — ...5-------a sq. ft. ............................................................................... <br /> Cn <br /> CD <br /> —`.—._------ ---- -- —— N — <br /> o O. <br /> i <br /> r. <br /> 0 <br /> -n :Ua <br /> Z C <br /> CD <br /> .y <br /> c m m co Z <br /> c m <br /> CD <br /> h bz' � m <br /> Z <br /> 0 <br /> :v 0 <br /> 4 Z <br /> m <br /> p <br /> i na ure of Owne4rge;in��� Date ° � C <br /> X <br /> emarks -n ; M <br /> ........................................................................................................................................................................ C C <br /> ...................................................................................................................................................................................... <br /> .......�..................................J..................... <br /> ispection Date ....................................... n,G,?. ... ...'..�12�ut'. 4! ................... �� 0 0 0 0 o Lr m <br /> Zoning Admin rator t� . . 0 0 0 0 C o 0 <br /> 'lel lnspectron must be made and site approval granted on all structures involving sanitary facilities <br /> fore construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> is application before a permit will be issued. Do not purchase or install a septic tank, do any plumhing or start any build- <br /> I until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> th 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 />