Laserfiche WebLink
Burnett County Office of Zoning Administrator <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT »' 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work de <br /> scribed and ~ <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the Stateof Wisconsin. _. _ <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT-11-11111-111 <br /> � s <br /> y <br /> ..` KI... ..) ......................... . .................................................................................. ....... <br /> A'DDrSS1 + ADDRESS 024- 64 <br /> .......1....... . ........... .................................. <br /> .......... ' <br /> . ............... ......................................................... ....... ! <br /> ADDRESS ADDRESS <br /> ....... . .... .. .................................................................. . <br /> PHONE � "•••• /f <br /> ...................... <br /> ........V �y-. .................................... PHONE W <br /> PLUMBER . ........... . .. . ............................................................... ....... <br /> BOO "15 <br /> WE LL DRI LLER <br /> IJJ.........s....... ..,....�,v.k-j <br /> .................................... .................................................................................... ....... <br /> ADDRESS ADDRESS <br /> O <br /> gtp6_�toa ' o €r <br /> .................. .............. ........... .................................... �. <br /> PHONEPHONE........................................................................ ....... •Z N .: :A <br /> DESCRIPTION o <br /> 4. Sanitary Facilities: I o <br /> 1. Work: 2. New Building Details No. Bathrooms <br /> Now Building ,.,,.... No. Bedrooms 0 ` `c <br /> Type of Construction: R <br /> AdditionSeptic Tank Size Gals. ih <br /> .......... .................................................... .. . . . <br /> :? <br /> Sanitary ...%q Size .............. ft. x .............. ft. v <br /> Filling/Grading ,,,,,,,,,• Height............. Stories ............... 4a. Absorption Field e: i0 <br /> Moving .......... Area ........................................... Soil Type ............................ ....... 'sin r i <br /> C <br /> Mobile Home .......... Slope ............................ ............. <br /> Privy <� Perc. Rate ...................... d <br /> 3. Use (describe exact) famil ;y <br /> Well „ ,,--,,., home,garage, motel,etc.) Dry Well ........ . :3 i <br /> Subdivision ...,..._._ Seepage Trench .......... Z <br /> .................................................... <br /> Camping Unit ........, Privy ... ...... (o'� - <br /> .................................................... T � <br /> --------------------- Seepage Bed .. ...... ? <br /> Location of Proposed structures and existing structures well sewage systems, roads, etc., should be sketched in Fl . A. .y <br /> Incl',ide road setback,side and backyard dimension and location and setback from all bodies of water. If property is located at :6 <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersect on. �., N <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. �” o <br /> -"--------------------- __ 1 0 T <br /> ______________________________________ <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. - ............................... sq. ft. ......... :� :♦1- i`tt <br /> .............................................................. ....... <br /> I <br /> eL- <br /> 0 0 <br /> _0 <br /> 0 N <br /> O : <br /> o 0 <br /> 3: f <br /> Some, A40J)eoL �a <br /> Z <br /> O <br /> 9 <br /> J <br /> i� <br /> V <br /> Al <br /> m mvmr > com -0 <br /> wiz < n > 0 c c_ m <br /> Q_ Lai = am nnm <br /> ic <br /> o oino � � >� 1 <br /> N, o <br /> o n In <br /> c In <br /> 0 10 <br /> C <br /> m � <br /> Q m . <br /> 0 <br /> Signaturof Owner or Agent ' .........Dae k : ^ O <br /> e <br /> o : : <br /> o . <br /> Remarks ....f ,.. r....�G'.7.!-.`,:%.`:.... " <br /> .................................................:. T: N <br /> m� a ' <br /> m �• <br /> g o <br /> ........................................................................................................ ....... ............. .. Ii U N � O O toll <br /> Inspection Date .. .......S. . : N N <br /> �........... ` a!I c.. ... . . :. m <br /> Zoning Administr t r $" $ $ $ y <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities before construction <br /> 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 <br /> be issued. Do not purchase or install a septic tank,do any plumbing or start any building until a permit has been issued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans orspecifications shall not be <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APP OVED. <br />