Laserfiche WebLink
0-77 (,1&""' <br /> Burnett County _ Office of Zoning Administrator o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT + 3 <br /> TO T"E ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as H o 0 �{ <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m e <br /> I CD <br /> Ordinance, Sanitation Code,and with al her applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 0- <br /> .r.. r......4..5.0................................................... ............................................................................................ — o <br /> a <br /> m (4 <br /> OW R (please print) ^ � CONTRACTOR or SURVEYOR or AGENT Qy� ' <br /> . ......... .d)....c..1�..................................... a <br /> AD ESS ADDRESS <br /> !f . <br /> Ct <br /> ............n....?. ^.7............ .c...t............................. � <br /> ADDRESS ADDRESS W <br /> ................ ....................................................... ............................................................................... <br /> PHOKE PHONE <br /> 1 . l ...... ................................................... ................................................................... ,w.. . .. . . . . . . . <br /> PLUMBER WELL DRILLER <br /> ADDRESS ADDRESS 0 <br /> W <br /> o' <br /> PHONE PHONE Z H :7 <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details <br /> New Building No. Bedrooms ..... oa <br /> .......... Type of Construe n: :� C <br /> Addition .....�,.X.��r (, �............ Septic Tank Size Gals. +� :p <br /> Sanitary ... Size .............. ft. x .............. ft. ....` <br /> Filling ........•. Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving Area Soil Type .................................... r <br /> ................................... o <br /> Grading Slope .......................................... <br /> .......... ? <br /> Mobile Home .......... 3. Use (describe exact) 1 famd Perc. Rate ................................... <br /> .4 <br /> Privy .......... home,garage, motel, etc.) Dry Well S <br /> Well Seepage Trench .......... <br /> Subdivision .................................................... Privy <br /> .................................................... <br /> Seepage Bed 1. . . <br /> ---------------------------------------------------------------------- cn c� <br /> Location of proposed structures and existing structures,well,sewage systems, roads,etc.,should be sketched in Fig. A. Include road C: <br /> a <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- C Q- <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING T <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> o' <br /> —————————————————————————————————————————————————————————————————————— �� 3 <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x ft. sq.ft. <br /> Cn <br /> CD <br /> 40 C <br /> c° <br /> `\ ._n D <br /> O <br /> D3 <br /> v <br /> 7 <br /> CD <br /> (D <br /> s <br /> cn co <br /> CD C � ,. � � CCD <br /> CD NQQ< -'+'CL <br /> 6N, N � fG g m <br /> Z o O CD CD <br /> o lea �. <br /> o 70 <br /> .. ....... ........................... ....................3� ............. p <br /> Si at re of Owner Agent Date e° C <br /> Remar ,e� .... ..... ........x1...Q. t!. .............................................................................................................. � v <br /> CD <br /> ..�-....rr ..................................................................................................................................................................... <br /> ... .. .. ... . ... . .. <br /> f �3 CTt N <br /> Inspection Date . �.. o 0 0 0 o cn rm <br /> ........................ 9......... <br /> Zonin Ad nistrator o 0 0 0 0 0 rn <br /> NOTE: 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 /> this application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build- <br /> ing until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> with 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 />