Laserfiche WebLink
bnc Y. <br /> Burnett County Office of Zoning Administra or v ;F c <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 <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of he ,� C 'x <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws nd <br /> regWatlons of the State of Wisconsin. » _ <br /> -yy--- / — <br /> O1. C..! ..... .� .1.�.... j.0.. !........................... . ................. `e. .......................................... ..... a m <br /> OWNER (pie print) CONTRACTOR or SURVEYOR or AGENT <br /> .....WTr......W�..s..,... a7.S:1...!..�......... . ...... . ........................................................................... . <br /> . . .... <br /> ADO 55 ADDRESS .do <br /> ...... . ...3'Li.................................................... .................................................................................... ..... <br /> ADDRESS ADDRESS :7 <br /> ............................... ....................................................... ....... ...............................................................................PHO Et ....... ..... <br /> PHONE <br /> v <br /> ..K,n r <br /> PLUMBER WELL DRILLER • <br /> O <br /> ADDRESS ADDRESS n 0 T <br /> . . .................................................................... .PHONE.......................................................................... ..... ,�: <br /> PHONE <br /> Z <br /> DESCRIPTION <br /> 4. Sanitary Facilities: - o <br /> 1. Work: 2. New BuildingDetails No. Bathrooms .... . ? c ? m <br /> New Building T No. Bedrooms <br /> .......... ype o�onsttupion: g i iZ <br /> Addition ,,,,,,,,,, , , , r0 r C�e r Septic Tank Size Gals. . ..... `] 2 <br /> ... . . ... ....................................... P ... <br /> Sanitary ..X... Size .....!.�.. ft. x .....fe..Q... ft. �. <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving ... Area Soil Type .............................. ..... <br /> .. . <br /> Mobile Home Slope .................................... ..... � <br /> o <br /> Privy .......... 3. Use (describe exactly "1 -family Perc. Rate ............................. ..... <br /> Well Dr Well ..,. ..... <br /> .......... home,garage,motel, etc. Y <br /> Subdivision .......... Seepage Trench z <br /> Camping Unit Privy ,,. .... <br /> ............. Seepage Bed �.. <br /> ---------------------------------------------_______ _ _ •N <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. w c 'rnC <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is locate at :I' 1 <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersecti n. 'C1 `— <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. p-------------------------------------------------------------------- - ' <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ft. x .............. ft. — ....... .� ...... .. sq.ft. ......................................................................... ..... <br /> N O <br /> O <br /> v <br /> 0 0 <br /> V: W <br /> R 0 pZ <br /> a <br /> 60 n «`v > > > `o Co <br /> p0. ; <br /> Z 00 o O o m <br /> '2 o. <br /> N n •� <br /> O <br /> 0 : O <br /> A : m <br /> .... ....�. Q...�" 9 <br /> Signa ursY-0 <br /> or Agent Date <br /> o : <br /> m ' u <br /> Remarks ....................................................................................................................................................................... . _ <br /> m •• <br /> �. <br /> ...................................................................................................... c : $ <br /> ...... ..... <br /> Inspection Date ....................................... N� N N T <br /> . . . . . . ... .�m .. u, , v, o o u m <br /> M <br /> Zoning Administrator $ $ $ $ $ $ y <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facil ties before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this applic tion 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 been issued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or sp 3cifications shall not be <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPR VED. <br />