Laserfiche WebLink
Burnett County Office of Zoning Administrator v CD 0 0 <br /> APPLICATION FOA SANITARY LAND USE — BUILDING PERMIT 3. .� <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as y 'C <br /> shown herein. Therundersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land UseCD <br /> m :� <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. o <br /> EL <br /> CD <br /> t.::L....�cr�K....................................................... N h <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a <br /> � ��/ti 1r_-rr 4 <br /> .. . .. ............... ... .......................................................... ............................................................................................ <br /> ADDRESS ADDRESS + <br /> /.. . .. .......� � ."............................. ............ ............................................................................... <br /> ADDRESS:. ADDRESS `�3 <br /> ....................................................................'. <br /> PHONE,— ......... PHON.E...................... ......................................................... <br /> C�^ N- .....L'� r .ar..r. (T..... tip, .................................................... <br /> PLUMBER WELL DRILLER <br /> ` �12C: .(. �"t ...... . .�......... .v ............................................................................................ v <br /> ADDRESS / ADDRESS t.r o <br /> PHONE PHONE <br /> z H r <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> �h Bathrooms 1. Work: 2. New Building Details No. " "' ' C o <br /> New Building Type of Construction: No. Bedrooms <br /> Addition Septic Tank izls. <br /> 111����� <br /> Sanitary <br /> Filling .......... Height............. Stories ............... 4a. Absorption Pjdld Site: <br /> Moving Soil Type ................................. <br /> .......... Area ........................................... 3 r <br /> Grading Slope ..................................... .... o <br /> .......... y <br /> Mobile Home .......... 3. Use (describe exactly, 1 -famil Perc. Rate ............................. . <br /> Privy .......... ome garage, motel, etc.) Dry Well <br /> Well Seepage Trench <br /> Subdivision Privy , <br /> .................................................... <br /> Seepage Bed v <br /> ------------------------------------------------------------------- --f7 <br /> rn <br /> Location of proposed structures and existing structures,well, sewage systems, roads,etc., should be sketched in Fig. A. Include oad <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway i t <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTI G <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. c N' A <br /> o <br /> 5. Lot Siz_� ----�n---------�------Fig. A. 6. Location--,—/_____________--�—^--�e—� <br /> . .. ft. x .............. ft. — ..... Q....... sq.ft. �%...... ... .F... f/..�4.....'1..!�! ? <br /> CD <br /> N O <br /> t~ o <br /> 3 <br /> `T <br /> N a• <br /> -n w <br /> ZZ V <br /> o <br /> v <br /> CD <br /> m <br /> cnr � ���� <br /> c d mCD <br /> rQ <br /> 70 m —. <br /> oy,c m <br /> z oo ° <br /> o - �. <br /> Zgeknt <br /> :� o m <br /> ....... .. .......... . .... ........ ....... :.. ..... _ pSigna ure of Owner Date o <br /> X <br /> Remarks ......................................................................................................................................................................... _ rn <br /> CD <br /> CD <br /> : v <br /> .......................................................................................................i ..................,Q................................ ........................... N <br /> Inspection DateLyrnEO /"• i \ o 0 0 0 o is m <br /> :................g...... <br /> Zonin A inista or . . 000000fn <br /> OTE: A preliminary site inspection 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 /> 's application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build- <br /> until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> 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 />