Laserfiche WebLink
Burnett County Office of Zoning Administrator Ln no 0 0 <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 and located as v, 0 iV1 <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m C <br /> Ordinance, Sanitation Code, and with all other applicable County Ordin as and the laws and regulations of the State of Wisconsin. 3 a tU <br /> ...... �...:&. ................................ <br /> ........................................................... ........ <br /> OWNER (please print) CON RA OR or SU RV VOR or AGENT a <br /> .. .................................................................. .s .! �� 7 a <br /> r...... <br /> ADDRESS AD E$S � <br /> s ,� .C......'A..... .....y�................................ s . 4< sy��a _ <br /> ADDRESSADDRESS /...... ............................................................. <br /> PHONE PHONE 'v1 <br /> PLUMBER . .......................................................................................... :\N� <br /> WELL DRILLER <br /> ADDRESS <br /> ....................................................................................... ... ............................................................................................ <br /> ADDRESS i m' •L� <br /> S6 <br /> n O <br /> PHONE . ................................................. ............... . <br /> PHONE . ...................... O N » <br /> DESCRIPTION 4. SanitaryFacilities: r`•H H v, ° <br /> 1. Work: No. Bathrooms ~ <br /> 2. New Building Details •..•••..•• <br /> New Building .......... Type of Construction: No. Bedrooms .......... f w <br /> Addition ......I... .................................................... Septic Tank Size Gals. .......... ,� N <br /> Fix <br /> Sanitary .......... Size .............. ft. x .............. ft. .......... A <br /> Filling/Grading Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving Area ........................................... Soil Type .................................... >,: <br /> o r <br /> Mobile Home Slope .......................................... <br /> .......... <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... .� <br /> Well home,garage, motel, etc.) Dry Well .......... w <br /> Subdivision .. ....... .................................................... Seepage Trench .......... L :l <br /> Camping Unit ,,,,,,,,,, Privy .......... o :� <br /> .................................................... Seepage Bed <br /> ---------------------------------------------------------------------- <br /> 01, <br /> Location of proposed structures and existing structures well, sewage systems, roads etc., should be sketched in Fig A. Include road h O <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter O a <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING O < <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. vl <br /> o' <br /> ------------- ---------- <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... sq.ft. ............................................................................... i <br /> s <br /> N <br /> O j <br /> ul <br /> 0 <br /> s <br /> :O <br /> Z <br /> O <br /> m <br /> m <br /> (n <br /> A C N 9 < N W N <br /> m a <br /> m <br /> Z o '— <br /> m <br /> on 01 <br /> �'v o <br /> FG ' <br /> .......... � <br /> s /.... .q......... _ m <br /> Signature of Owner or Agent Date ° C <br /> X <br /> Remarks ............................................................................................................................ A In <br /> �. <br /> m <br /> ....................................................................................................... .11 . . <br /> Inspection Date ....................................... <br /> I ym <br /> .......... onn $ $ $ $ $ZAdm <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 must 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 be made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />