Laserfiche WebLink
Burnet County Office of Zoning Administrator <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT m 3, .� <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and 'Z �. <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the C -) <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 , <br /> regulations of the State (Wisconsin. a <br /> ��.t.d.......Kw*. ,.�t. ..... ............................................................................................ <br /> s� <br /> ................. <br /> OW ER (please print) _ CONTRACTOR or SURVEYOR or AGENT <br /> ....Mal...laK� .J ��a,. .... ............................................................................................ d <br /> A OR ADDRESS <br /> ....: . 5 �ff <br /> ... ................................................................................. <br /> w : <br /> W <br /> ADDRESS r ADDRESS ^1 <br /> PVN ..-.. .. ...................................... .PHONE................................................................................ ;I., 1 <br /> .................. ............................................................................................ J �\ <br /> P MBER i <br /> WELL DRILLER :�Q <br /> ...:IJ. 4:.,....� tlG. ..,..11...... ............................................................................................ o <br /> ADDRESS ADDRESS.................................... ....................................... r�0i p <br /> X1 .5..-..y.� .-... ?�.3. <br /> .... ............................. ............... .. <br /> � o <br /> PHONE PHONE Z ,fin r <br /> DESCRIPTION 4. SanitaryFacilities: °n o °» <br /> 1. Work: No. Bathrooms <br /> 2. New Building DetailsX J 'o <br /> Nev,Building .......... Type ,Cons cp' No. Bedrooms <br /> Addition [l�.. . ,.. SeptjcTank Si <br /> lze Gals. <br /> Aci IL 1 <br /> Sanitary Size .............. ft. x ft. <br /> Filling)Grading ,,........ Height............. Stories ............... 4a. Absorptioield Site: i <br /> Moving .......... Area ........................................... Soil Type .................................. <br /> Mobile Home Slope ........................ ... o <br /> .......... r <br /> Privy .......... 3. Use (describe exactly,'1 -family Perc. Rate ................................... i <br /> Well .......... home,garage, motel,etc.) Dry Well .......... m f <br /> subdivisionSeepage Trench Z ' <br /> 01 <br /> Privy .......... <br /> CampingUnit .......... .................................................... <br /> Seepage Bed .......... L <br /> ------------------------------------------------------------ t rn <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. C <br /> Include road setback,side and backyard dimension and location and setback from all bodies of water. If property is located at g <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersection. `- <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> ______________________________________________________________________ <br /> 5. Lot Size: Fig. A. 6. Location: <br /> O <br /> ................ ft. x .............. ft. . ............................... sq. ft. ............................................................................... <br /> C7 � <br /> n <br /> N O <br /> O = <br /> _ <br /> to <br /> See <br /> f <br /> V <br /> Z <br /> Z <br /> 0 <br /> v <br /> _ <br /> ua <br /> m <br /> M in V Nr DID to -a <br /> m Nam - C n a y <br /> c N <br /> Z.-.O >D � 1 <br /> ON= <br /> inO A <br /> e c' = m <br /> %� n : m <br /> Signature of O ner or Agent Date 8 <br /> Remarks ..... n <br /> m •� <br /> m <br /> 0 <br /> � p� <br /> I1 N m <br /> Inspection Date ....................................... 1u�.. ... ..... ......... ............ m. . .oning Administrf o 8 0 <br /> 88 (1) <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this application 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 specifications 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 />