Laserfiche WebLink
Burnett County Office of Zoning Administrator -� <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <br /> d <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as y o <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use _CD c <br /> Ordinance, Sanitation Code,and with alall other applicable County Ordinances and the laws and regulations of the States of Wisconsin. 3 a <br /> (.(�.. . .. �.4�.Y.�..Q.. ............... Gac .... `-� ?cc. U✓(�' — o <br /> ........ ... .... . .. .............................. A <br /> OWNER (pleas print) CONT ACT R or SURVEYOR or AGENT CCD m <br /> Qom . <br /> ........................................................................ _ <br /> AdDR SS � ADDR S � Q� <br /> ...Ir .............. ............................... <br /> ADDRESS �..............�..�c.................................... �.� • <br /> _ ADDRESS <br /> PHONE PHONE (' <br /> ........................................................................................... .W.E.......D..RI..L <br /> .. ........................................................................... <br /> PLUMBER LL LER <br /> ............................................................................ ......................................................................................... m C) <br /> ADDRESS ADDRESS �' <br /> < ; <br /> .......... p' '. ; <br /> PHONE PHONE z H <br /> DESCRIPTION r <br /> 4. Sanitary Facilities: ° o o <br /> 1. Work: 2. New Building Details No. Bathrooms _00 <br /> New Building Type of Construction: No. Bedrooms .......... -0 <br /> m <br /> Addition Septic Tank Size Gals. .......... ;... .. ........................... . <br /> Sanitary .......... Size .............. ft. x .............. ft. .......... <br /> Filling .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> MovingSoil Type .................................... <br /> r.......... Area ........................................... yp <br /> Grading .......... Slope .......................................... ° <br /> Mobile Home .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Privy horpe, rage, motel,etc.) Dry Well .......... <br /> Well ........ . n LIle .. ... Seepage Trench <br /> Subdivision Privy .......... p <br /> ................. .................................. . <br /> t <br /> -------------------------------------------------- Seepage Bed---------......... 4_1 <br /> CA Cl)Location of proposed structures and existing structures,well,sewage systems, roads,etc.,should be sketched in Fig. A. Include road C: <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- CIV C <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 /> —————————————————————————————————————— <br /> o <br /> 5. Lot ize Fig. A. 6. Location: vv <br /> �7 <br /> ..0... ft. x .. 6(/ ft. — G,�� O U G sq.ft. ....... 5 ........ <br /> !.v....................... <br /> N 0' <br /> o <br /> :Is\ <br /> 21 <br /> CD <br /> CDC (D <br /> 0 <br /> ems = < - _ CD <br /> U �T EHCj e/f o ff ? ' g m <br /> o <br /> ifs 5' <br /> N, <br /> •O o � <br /> 1..... :........ �� p <br /> gnature of Owner or Ag t Date C <br /> X 70 <br /> emarks -n c ; m <br /> m <br /> EA <br /> ...................................................................................................... <br /> ..................... : o <br /> spection Date fr <br /> 000CD M <br /> ....................................... <br /> 2 nin Adm' istrator o 0 0 0 0 o 0 <br /> )TE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> Ore 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 /> h 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 />