Laserfiche WebLink
Burnett County Office of Zoning Administrator 0 o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3• _ �� <br /> o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as '� 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 � <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> .............. V <br /> a <br /> C.........../..........:............................................................... o <br /> OWNER (Please print) CONTRACTOR or SURVEYOR or AGENT a <br /> t'' <br /> ADDRESS <br /> .................................................................................. ADDRESS <br /> ADDRESS :cam <br /> ..... . . . ............................................................................... ............................................................................................ i� <br /> ADDRESSADDRESS <br /> ......s '.-....Y.X�.y.............................................. <br /> PHONE <br /> S � C <br /> PHON/yE� ' <br /> .(v ......................... ................................................ .WELL DRILLER................................................................... <br /> PLUMBER ' <br /> G�To� . . . . . . ............................................................................... 0 <br /> . ... "{/............................................................................ ADDRESS <br /> ADDRESS <br /> 0 <br /> ............41.Y............................ ......................................... . . . . .................................................................................... <br /> PHONE PHONE 'Z r <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> No. Bathrooms <br /> 1. Work: 2. New Building Details o <br /> New Building Type of Construction: No. Bedrooms r�.. C <br /> .......... J v <br /> Addition Septic Tank Size Gals. �..J.G� :� < :� :(� <br /> ......... .................................................... <br /> Sanitaryt <br /> .... Size .............. ft. x ...s ........ ft. 4a. Absorption Fi�Jd.Sit� <br /> Filling .......... Height............. Stories ............... ) <br /> Soil Type ........ . r <br /> Moving .......... Area ........................................... o <br /> Slope ............ . ...................... <br /> Grading .......... r n,� „c/..... <br /> Mobile Home Percate ........... .......:............... <br /> 3. (describe exactly Tamil Dr Well �i <br /> Privy .......... hom ,garage, motel,etc.) y U <br /> Well .......... <br /> Seepage Trench <br /> Subdivision ""'" <br /> Privy <br /> Seepage Bed ... <br /> -------------------------------------------- <br /> -------------------------- <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- <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING - -} N• _0 <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. J o <br /> 5. Lot Size: Fig. A. <br /> ft. x .............. ft. — sq.ft. :a i i' <br /> N <br /> N : C! <br /> O O <br /> 7 <br /> ti <br /> L' T <br /> � ZI <br /> O <br /> n <br /> XI <br /> m <br /> CW2. co <br /> -o cn < 7 n <br /> o <br /> Z oo <br /> o <br /> :V N <br /> % O <br /> r <br /> ... ........................................ . ./...�/................ /✓...-V....� /... <br /> O <br /> Signature of Owner or Agent Date X <br /> Remarks ............................................................................................................................................................................ m E <br /> viU : <br /> ........................................................................................................................................................................................... : .II <br /> ........................................................................................................................... . ............................................... . <br /> Ocnocno <br /> Inspection Date ....................................... G ....c7!.: �llC 'r✓ 0 0 0 0 o I <br /> Zoning Administrator <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 />