Laserfiche WebLink
Burnett County Office of Zoning Administrator 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 'c N <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m e ��- <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a V :V <br /> CL .t <br /> L.e:�.?......... ''........ T....... {!..7 .r.S....................... ............................................................................................ <br /> OWNER (pleasep print) _p CONTRACTOR or SURVEYOR or AGENT a <br /> .................... n <br /> ADDRESS ADDRESS <br /> 1 <br /> ADDRESS `' ADDRESS i b <br /> ..n.fJ.t_R..e•.L........1.�.�1.......e9G. ../...- .. D..r�...................... ............................................................................................ [� <br /> PHONE. ............................................................................... PHONE <br /> . . ....... ........ ...................................................................... <br /> PLUMBER WEL.....L D.RILLE.R <br /> ..... . . . ............................................................................... .AD. ...D... . .RES.............................................................................. O 'o <br /> ADDRESS S m 0 <br /> ........................................................................................... . ......................................................................................... O .i <br /> PHONE P..HONE Z H r <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: 2. New Building Details No. Bathroomsr� o <br /> .......... r <br /> No. Bedrooms - <br /> New Building ,,,,X Type of Construction: •��� $ <br /> AdditionSeptic Tank Size Gals. .......... <br /> Sanitary .......... Size ..,.a.�.... ft. x ..,,, .. ft. .......... . <br /> Flilingl Grading . ........ Height............. Stories ............... 4a. Absorption Field Site: <br /> Type i <br /> Moving .......... Area ........................................... Soil .................................... r <br /> 0 <br /> Mobile Home Slope .......................................... <br /> Privy ,,,,,,,,,. 3. Use (desr' a exactly, 1 -family Perc. Rate ................................... <br /> Well home,garage motel, etc.) Dry Well �. <br /> Subdivision Seepage Trench .......... t <br /> .................................................... <br /> Camping Unit ,......... Privy .......... kA <br /> .................................................... Seepage Bed <br /> ---------------------------- .......... i„y y <br /> ------------------------------------------ on C <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched in Fig. A. Include road <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- Q a <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING — <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. r, o , <br /> ---------------------------------------------------------------------- <br /> 5. Lot Size, l Fig. A. 6. Location: 17 <br /> ft. x f�: 6...... ft. — ............................... sq.ft. ......................... .:. ........................................ O 4L p I <br /> iu, a <br /> ` 1 <br /> V,. <br /> _ <br /> ® O <br /> -o <br /> T <br /> i� EG\ <br /> y io <br /> 611 -D o <br /> l <br /> :rte <br /> mg no W ZILO <br /> M rim <br /> C m <br /> c <br /> Dam <br /> 0 0 5 : a � 7p <br /> e» = m 3 <br /> z <br /> 4.G.Y.....,.. .'........ :C..�................ ....F...._.......... .. U�o <br /> Signature of Owner or Agent Date <br /> X <br /> Remarks ......................................................................................................................................................................... T m <br /> ° <br /> v <br /> II <br /> ......................................................................................................... . ... .............. ..yy,. .... ........................ J.............. :ii <br /> Inspection Date ....................................... ..1Y/! .1............. ........... . i l o: G' o 8 a m <br /> ...................... . <br /> Zoning�tor 8 8 8 8 8�tn <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 conveyer] here- <br /> with is found to exist. Changes in plans or specifications shall not lie made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />