Laserfiche WebLink
Burnett'County Office of Zoning Administrator o d o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. <br /> o :O <br /> TO THE ZC*NING ADMINISTRATOR: The undersigned hereby mkes application for a Permit for the work described and located as •< H -^ <br /> shown herein. The undersigned agrees that all work shall be done iq 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 /> . .r.a.. ............►`A.tk..1.5.i.e..-s......................... ............................................................................................ � m <br /> OWNER (plelse print) CONTRACTOR or SURVEYOR or AGENT <br /> z .......s..r. . .a. . .........R.d....................... .............................................................................. d <br /> ADDRESS ADDRESS <br /> W -f. A.t.znn........ ........ ......................................................................................... � <br /> v Y\ •� <br /> ADDRESS ADDRESS O <br /> ........... <br /> PHDAIE PHONE <br /> ........................................................ <br /> 11 . . . ...... .. . . ....................................................................... >• ' <br /> . ............Y......... . � <br /> PLUMBER WELL DRILLER ip <br /> ................................................................. ............................................................................................ <br /> ADDRESS ADDRESS <br /> 0 O <br /> PHONE PHONE Z <br /> DESCRIPTION 4. Sanitary Facilities: I o 0 0 <br /> 1. Work: New Buildiyg Details No. Bathrooms o <br /> New Building Type Co,struction: No. Bedrooms iii i <br /> .......... <br /> .......... : <br /> Addition t , . , ,,,,,, Septic Tank Size Gals. :......... <br /> .......... ....../�. . . ... <br /> Sanitary ...L� Size ... .qft. x .....0•.. ft. <br /> Filling Height Stories ............... 4a. Absorption Field Site: <br /> Moving <br /> Area Soil Type .................................... K i r— <br /> Grading Slope .......................................... i <br /> Perc. Rate ................................... <br /> Mobile Home ....... 3. Use (describe exactly, 1 -family � <br /> Privy home,garage,motel,etc. Dry Well <br /> Well ,........... Seepage Trench .......... i <br /> ........................ .......................... . <br /> Subdivision Privy t ;Q) <br /> ................................................... �k <br /> Seepage Bed ..... .... io <br /> -----------------------------------_---------------------------------- \ to <br /> Location of proposed structures and existing structures, well,sewage systems, roads,etc., should be sketched in Fig. A. Include road :rte Q <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- - a <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING < <br /> o <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. H <br /> -------------------------------------------------------------------- Ju •� <br /> 5. Lot Size: Fig. A. <br /> ................ ft. x.............. ft.— ....... sq.ft. i <br /> N O <br /> O 7 <br /> A 7 <br /> 7 �. <br /> fa <br /> — <br /> Z <br /> ZJNJ <br /> z <br /> rn ''Ci <br /> Q N N : •G f0 <br /> Z 00 ' <br /> 0 <br /> O = ; <br /> � N .i � <br /> .._................................. : . <br /> C <br /> ................... o <br /> Signature of Ow r or Agent Dae M <br /> - M x . m <br /> Remarks ........................................................................................................................................................................... <br /> v <br /> 6q <br /> ............................... :�, M <br /> ..............................................................................................................................................::�...%.. :� <br /> 1 0Lnm <br /> Inspection Date ....................................... k : ............................... , 00 M <br /> o <br /> Zoning Administrator o 0 0 CA <br /> NOTE: A preliminary site inspection mus be riade ;nd site approval gr,:nt+d on all structures involy,i`g sanita v f cilitius <br /> before construction can begin. In the cas, of serverage disposal systems, a copy of the percolation tQst must b <br /> th application before a permit will be is,uad. Do not purchase orinsta'll a septic tank, do any plurimhv <br /> ir or s ' <br /> in it a p � <br /> permit has been issued. A permit may be revoked if misr�esentati„n of any of the inform, o <br /> is fo exist. Chan1jes in hl.,nso specilications shall not he made without approval of the Zon <br /> V SHALL NOT BE COVERED UNTIL INSPECTED EY THIS OFFICE AND A <br /> ,:w.; <br />