Laserfiche WebLink
Burnett County Office of Zoning Administrator d o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. _ :-A) <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < H .1, <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land [P',se ! ? � <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wiscon m 3 bc L/�I T} <br /> a . <br /> O <br /> ................................................... <br /> ..�•'..G.'?��3 ................................. ..... m :ice <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT o. <br /> ..., <br /> ADDRES ADDRESS <br /> ADD SS ................... .ADDRESS (. .Yj <br /> J <br /> PHONE................................................................................ .PHONE....................................................................... ... <br /> 784:0Son/ J t <br /> T- <br /> PLUMBER WELL DRILLER — <br /> �_ <br /> yC ...s +��.ih..S.!........sow.py..w ............ o <br /> ADDRESS ADDRESS m O ti! <br /> 7{s".-..b. s...-.a.y. .7....................................... <br /> ........................................................................................... O < :r. <br /> PHONE PHONED <br /> Zr <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° o� <br /> 1. Work: No. Bathrooms 'r <br /> 2. New Building Details <br /> g :�— <br /> New Building .... Type of Construction: No. Bedrooms <br /> AdditionSeptic Tank Size Gals. ev..el E,• i E <br /> .......... .................................................... < <br /> Sanitary ,,,!� Size .............. ft. x .............. ft. . . ...... <br /> FillinglGrading .......... Height............. Stories ............... 4a. Absorption Field Site: i <br /> Moving .......... Area Soil Type ............ ................ ...... o <br /> Mobile Home <br /> Slope ........,.(... ..�. <br /> Privy Perc. Rate .......-'....��............. ...... <br /> ..,,...... 3. Use (describe exactly, 1 �family : <br /> Well .......... home,garage, motel, etc.) Dry Well ... ...... <br /> SubdivisionSeepage Trench ... ...... i <br /> Camping Unit ...4...... .....................................4.............. Privy .. .... <br /> --------------------------------------- Seepage Bed------ <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched in Fig. A. Include oad Q <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXIS ING <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. I .// <br /> --------------------------------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... sq. ft. ....................................................................... ....... (� <br /> (fJ m <br /> n <br /> N O' <br /> /T O J <br /> ioJ/I J _ <br /> O � <br /> o <br /> Z 71 <br /> N <br /> `c <br /> 0 <br /> Ul <br /> r . <br /> m 2 <br /> n cr Z <br /> o n <br /> � <br /> Fir_I Q <br /> a o < E � <br /> Z o o' n , <br /> o J am <br /> !Ja FIR <br /> O �p <br /> s>. <br /> o C <br /> ignature f Owner or Agent Date <br /> //�J ,{/ x : : . . 0 <br /> Remarks .�-!..Cl.... ....�iQ li E ...... ... '7 : <br /> M <br /> ................................................................................................................................................................................... .... — <br /> II <br /> ............................................................................................................. . ............. .... ........................................ .... : . . : . T <br /> Inspection Date ./....../.�2..'. CJ......... .......nis ......................... .... m <br /> o 0 o <br /> Zoni Administrator j: 8 8 S 8 8 8 y <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures ini olving 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 riot 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 />