Laserfiche WebLink
Burnett County Office of Zoning Administrator ;v - o Z <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as � H Q <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land UseCDc h 9J <br /> Drdinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. a <br /> t: — <br /> . .. ..� .�. :...... .azz..n ....... 4214.�.r'rU..w.........�� '.s......................... <br /> Za <br /> please�rint) CONTRACTOR or SURVEYOR or AGENT cn m <br /> /..10. . ......Ai .... ................................... �/1✓.Q..�J. �1... Q.. ...... .1................................... Q <br /> ADDRESS ADDRESS h <br /> ...� �.J�....�.... /.�..-..6-Y..�..�..3.. <br /> ADD ESS ADDRESS '� <br /> 'HONE PHONE <br /> .................................................. .WELL.........D..RI..LL.. ....E....................................................................... ; \ <br /> 'LUMBER R <br /> .............................................................................. .......................................................................................... <br /> ADDRESS ADDRESS <br /> 0 Q <br /> .............. P H..ONE....................................................................................... o <br /> 'HONE 0 <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> I. Work: 2. New Building Details No. Bathrooms ........ . <br /> D <br /> o <br /> New Building Type of Construction: <br /> No. Bedrooms .......... -0 <br /> Addition .......... }��(},.....••„•••..•• Septic Tank Size Gals. <br /> r <br /> Sanitary .......... Size ..I.L..... ft. .......... ^u <br /> Filling g 4a. Absorption Field Site: <br /> .......... Hei ht............. Stories .....�...... . <br /> Moving Area Soil Type .................................... i— <br /> : <br /> Q <br /> Grading Slope .......................................... <br /> Mobile Home .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Privy .......... home, arage motel, etc.) Dry Well r� <br /> Well •„......• Seepage Trench .......... '• <br /> Subdivision ...............................I.................... Privy .......... <br /> .................................................... Seepage Bed <br /> Cn <br /> -ocation of proposed structures and existing structures,well, sewage systems, roads,etc.,should be sketched in Fig. A. Include road Qu c: .� <br /> rs <br /> etback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- Q- 1�1 <br /> ection, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING �' < <br /> ;TRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> _______________________________________________ V Q <br /> a <br /> i. Lot Size: � Fig. A. 6. Locati n: <br /> �/ <br /> ft. x .............. ft. — / Gar C /4�� S yr /' / <br /> sq.ft. 4../../..A.A.d.......................... <br /> Ld 77 W e1/V- S ,li�r ��L -00 0 e oT <br /> Cn <br /> CD <br /> n <br /> o <br /> o <br /> V N <br /> U o a <br /> CD <br /> I <br /> te C/)WZ <br /> CD <br /> CD <br /> m - <br /> rA00 o �� <br /> cn <br /> �t o <br /> /dam ......... ...11.-...Y.....`... .:......0,"d` ......�... �... <br /> ignature of ner or Agent Date — <br /> X <br /> :�.emarks ......................................................................................................................................................................... „ mm <br /> Co <br /> ....................................................................................................P...................................... ?V>< <br /> Ln _.N <br /> LmLo ......... ..... .................. 00000cnm <br /> ispectionDate ....................................... ............... ....... ........ ?�?✓............. o 0 0 0 0 o m <br /> Zoning Administer <br /> ATE: 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 /> is 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 /> th 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 />