Laserfiche WebLink
T�C.fl9p�. <br /> J <br /> Burnett County Office of Zoning Administrator COO 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3 :\ <br /> o :\ <br /> TO THE, ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as m <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use c <br /> Ordinance, Sanitation Code, and wiiitt�h� alylll��other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 <br /> ........J.•s..C� ......................... . . . . . . . . ........................................................................ O <br /> n <br /> w <br /> OWNER (ole e print) CONTRACTOR or SURVEYOR or AGENTic, a <br /> .8. .�.....�. --...z, . �.: .. ................. ............................................................................... <br /> ............. <br /> ADDk /SS, ADDRESS <br /> ......: .^"'.""..`. ...:a:U:�:�..fif .`.`.��.".^�'r .1.7?yrw^A✓,r.-�.� . .......................................................................................... <br /> ADDRESS `/ ADDRESS fv :Z <br /> 6.1. .."...` ... 1...-..b................................................... ............................................................................................ a <br /> PHONE ....... ..... . .. ...... ... ...... . . .. ... .. ....... ... . ... . .. . . .. . . . PHONE <br /> ............ <br /> ............... . . . WEE" ,L..L.... ................................................................ <br /> .. ...... .. . <br /> PLUMBER DRI.. LLER <br /> O <br /> .......... <br /> ADDRESS............................................................................ .ADDRESS. . ......................................................... 0 O <br /> ........................................................................................... .............. ...... .. ................................................................ : j ». <br /> PHONE PHONE Z v, r <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms .......... o <br /> o <br /> New Building ...... Type of Construction: """"" <br /> No. Bedrooms <br /> Septic Tank Size Gals. .......... <br /> y . <br /> Sanitary .......... Size .....L .. ft. x .�Q......... . <br /> ft. ........ , I <br /> Fillingf Grading .,,,,,,,,, Height............. Stories ............... <br /> 4a. Absorption Field Site: <br /> .................................... r <br /> Moving .......... Area ........................................... Soil TypeO <br /> Mobile Home .......... Slope .......................................... ^ <br /> Privy .......... 3. Use (describe exactly, 1 -family <br /> Perc. Rate ................................... �. <br /> Well .......... hom/R�,gara e, otel, etc.) y <br /> Dr Well .......... to <br /> Subdivision J+J rc.t,�, Seepage Trench .......... i E <br /> .......... .......................... ......I...... t <br /> Camping Unit .......... Priv .......... Ji <br /> Y <br /> .................................................... Seepage Bed <br /> ____ U <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched In Fig. A. Include roadg, 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- a <br /> section, show the Intersecting highways and the setbacks required along them and at the Intersection. CLEARLY LABEL EXISTING <—s <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. t o <br /> ---------------------------------------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. . ............................... sq.ft. ............................................................................... <br /> m <br /> n <br /> N O <br /> o q J <br /> 2. <br /> 3 N <br /> O <br /> o <br /> 1 � <br /> O <br /> 7J <br /> d <br /> V O <br /> d � <br /> C N S d C N <br /> rD N O- c: d rD <br /> O m D n <br /> Z C,o n <br /> E» — <br /> €AJ� <br /> ...... .JI .�Q:Fr`.:L'.. . ...................................... <br /> Signature of Owner or Agent Date <br /> X <br /> m <br /> Remarks ......................................................................................................................................................................... � m0 <br /> n : <br /> ........................................................................................................................................................................................ <br /> il <br /> ...................................................................................................... .. .................... ..... .. ..... n <br /> u) <br /> o: <br /> ° NN , m � Nm <br /> InspectionDate ....................................... .. e� .....: ..... ........ ...................... 8 S S 8 8 8 N <br /> Zoning Admi Istrator ,CJ <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 most 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 lie made without approval of the Zoning Administratof. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />