Laserfiche WebLink
n� <br /> Burnett County Office of Zoning Administra or �' o <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 described nd •2 M <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of he ,$ c <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws nd 3 <br /> regulations of the State of Wisconsin. ` g <br /> ..`= S� vs � .� s � 7 .. �4dr /� <br /> ...... .. ,. .r............................................. .. e..:I. . ................................... ..... <br /> OWNER (please print) CONTRACTOR or SURVEYOR or GENT ; <br /> X...../...3.. . <br /> ' . . . . ......... ..... 1� <br /> ....................................................... ................................................................... .. . . . . <br /> ADDRESS ,may,, ADDRESS - <br /> ...../..1. C:./1...!-F. ...."'.4..h...�..... ........... .ADDRESS............................................................................ <br /> ADDRESS <br /> i l � <br /> PHON ....................... PHONE J(\pr� i <br /> ..... .. ... . <br /> . ' ..tC>.�z..�.......................... ..................................................................................... ...... E�c ; <br /> PL ME WELL DRILLER <br /> .....�1���,. - ...+C.at..{...l:n� ...... ..1. .................. ..................................................................................... ...... <br /> ADDRESS ADDRESS n o �^ <br /> c :r': <br /> ........................................................................................... . . . . ............................................................................. . O <br /> PHONE PHONE <br /> DESCRIPTION 4. Sanitary Facilities: ' ro <br /> 1. Work: No. Bathrooms ` <br /> 2. New Building Details ••• •••••• C-) o <br /> New BuildingNo. Bedrooms <br /> ...x.. Type of instruction: �� ��` R • <br /> Addition r`G ».—C Septic Tank Size Gals. ... .....J EJ , <br /> Sanitary ...,�0... Size ....di..D.... ft. x ..3.�..... ft. 7 ...... �..J� i <br /> Filling/Grading .......... Height........... Stories ............... 4a. Absorption Field Site: <br /> til <br /> Moving Area ........................... ............... Soil Type ............................. ...... r <br /> .......... i <br /> Mobile Home Slope ................................... ...... �� w <br /> .......... <br /> Privy .......... 3. Use (describe <br /> ..... .. exac..t.l 1 -family Perc. Rate ............................ ...... <br /> homeDry Well.......... , l <br /> Seepage Trench oSubdivision .......... ... <br /> '. <br /> Camping Privy <br /> Unit .......... ............................................. ...... <br /> Seepage Bed -- <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. :_z' <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is located at <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersect on. ;lJl <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o <br /> _ ______________________________________ __ <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — sq.ft. ....................................................................... ....... <br /> N <br /> N O <br /> cn <br /> H � <br /> \ <br /> A <br /> r <br /> `1\ <br /> LD. < o <br /> a m _n <br /> y N <br /> O : N <br /> O NO D <br /> 2 on <br /> O <br /> 13-g� x t, : rn <br /> ...y . <br /> . .............................. $ <br /> Signature of <br /> Own or Agent Date <br /> T : N <br /> Remarks .................................................................................................................................................................... .... m a <br /> N <br /> g . <br /> ........................................................................................................... .... .............. <br /> 111 <br /> Inspection Date ....................................... .... .... ... .. ................ ... v, u, u' o o u, m <br /> Zonin dministrator 8 8 8 8 5 8 rn <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary fa ilities before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this app)cation 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 beer issued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or pecifications shall not be <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />