Laserfiche WebLink
M Co <br /> Burnett County Office of Zoning Administrator W c <br /> APPLICATION OR SANITARY — LAND USE — BUILDING PERMIT 3. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and <br /> located as shown herein. The undersigned agrees that all work shall be done in accordan with t e require ents of the ,� c <br /> Burnett County Land se Ordin nce, Sanitation Code, and with all other applica Cou y rdina ces an the laws and 3 `a q <br /> tions of the tat IWisco sin. — `vY <br /> ... ..... . . .................... .. .. te, .... ... .... ............�'.�'.................... <br /> a <br /> kS- <br /> OWNER (pt ri tl �,.,C RRA�CTO(�`�or SUR EV o GENT A <br /> .... .. .... r.:...... . l.!'.�:-' \ ....(..`..l`.`�/.1.✓ �.'� ;V`� �: <br /> AD ES ESS •••••••• •• <br /> . .ESS ....,l,.l„`... ............ L.L ...... ... D ESS. . .�.,�1.......... ...........t....... . ..U.`...I. <br /> . . . <br /> ��,.-........r. .......... ��.............................. .PHONE...............................��.:.J......... <br /> :ice• <br /> .............. <br /> ................................................. ......................................... . ........... . ......................................................... <br /> PLUMBER WELLDRI LLER <br /> ................................................. ......................................... ............................................................................................ O <br /> ADDRESS ADDRESS 'm 0 <br /> 0O <br /> ........................................................................................... ............................................................................................ O r <br /> PHONE PHONE ' <br /> D S TI N Z 0 r <br /> 4. Sanitary Facilities: � o °» <br /> I. Work: No. Bathrooms <br /> •tv 2. New B ddin etails ••• •••••• <br /> Now 6ulldino y e o tfuct' n: No. Bedrooms .......... <br /> .. ....... /T� �p <br /> Addition \�f, ',�.,,,,,,, ,Lltiti'� �Ptic Tank Size Gals. .......... <br /> Sanitary .. ....... Size . ...I ft. x ......14. ft. .......... ' <br /> Filling/Grading ,, ....... Height.`.2.5... „••„N 4a. Absorption Field Site: i <br /> Moving .. ....... Area ... . .'r Soil Type .................................... E . <br /> .................... r <br /> Mobile Home $OPe .......................................... <br /> o <br /> Privy3. Use (describe exactly,'1 family Perc. Rate .........................0......... <br /> Well ,, ....... home,garage, motel, etc.) Dry Well .......... M <br /> Subdivision .. ...,... Seepage Trench z '• <br /> .................................................... <br /> Campin Unit .. ......, Privy .......... : ) <br /> .................................................... Seepage Bed V” ' <br /> Location of proposed structures and existing structures well sewage systems, roads, etc., should be sketched in Fig. A. cn <br /> Include road setback,side and bz ck yard dimension and location and setback from all bodies of water. If property is located at ("D <br /> a highway intersection, show ft e intersecting highways and the setbacks required along them and at the intersection. <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o� <br /> 5. b Fig. A. 6. o ion: <br /> ..... ft. x .............. f . . ..........................�..�..Y. sq;.�ft. \ f.'.-W ... ..... <br /> o <br /> w <br /> �- <br /> f <br /> cJ?.Z�V\ ! <br /> N <br /> W �c� 0 <br /> �. 41C�1'�101 ' .N T D C3 mcl. CL <br /> � <br /> c/L �h Zey : � � om �' 3 <br /> t o v'� � '2 n : 1 <br /> n yo : <br /> — o o m <br /> A .. .. . .......... D.....-t`�........... x n o <br /> Signature of Owner or Agent ate <br /> 8 : <br /> Remarks <br /> m �• <br /> o <br /> ................................................. ........................................................ ..... ................ ............................................... 1 g <br /> w �I <br /> Inspection Date ....................... ............... .. ...... .........:� N a o N m <br /> ........................................... <br /> Zon' Administrator 8 8 8 8 8 CA <br /> NOTE: A preliminary site i spection must be made and site pproval granted on all structures involving sanitary facilities before constru on <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 purchas3 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 misrepresentatic n of any of the information conveyed herewith is found to exist. Changes in plans or specifications shall not be <br /> made without approval of If a Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />