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 o :V <br /> shbwn herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use _ c <br /> Ordnance, Sanitation Code, <br /> /and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 n <br /> ...D I �01�`.�/s.Sd. A N ° <br /> OWNER (please print�) CONTRACTOR or SURVEYOR or AGENT a V <br /> ADDRESS s—�+y ADDRESS C <br /> ........................................................................................... kA <br /> ............................................................................................ <br /> ADDRESS ADDRESS <br /> :rb <br /> ............................................... .. ...................................................... . . . ...................................................................................... <br /> �G <br /> PE PHONE <br /> eo <br /> LUMBER � y S^ 3 WELL DRILLER <br /> pis I / 5�....................... ...... . ............................................................................... JY <br /> o <br /> ADDRESS ADDRESS .n <br /> = o <br /> w C) :n <br /> n < <br /> ........................................................................................... ............................................................................................ O _ <br /> PHONE PHONEz H ' <br /> DESCRIPTION r <br /> 4. Sanitary Facilities: � (J° o ° ' <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details �'`C 0 <br /> New BuildingType of Construction: No. Bedrooms <br /> ao <br /> Addition Septic Tank Size Gals. 7.5..... <br /> Sanitary Size .............. ft. x .............. ft. J <br /> Filling Height............. Stories ............... 4a. Absorption Fi d Site: <br /> Moving / <br /> .......... Area ........................................... Soil Type .. i�. C7............... r <br /> o <br /> Grading Slope ...........�.. ;(\1s <br /> Mobile Home .......... 3. Use (describe exactly, 1 -family Perc. Rate .......... ................... T <br /> Privy .......... home,garage,motel,etc.) Dry Well .......... W E� i <br /> WWell Seepage Trench <br /> Subdivision Privy Wi <br /> Seepage Bed <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- _L <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.---------------------------------------------------------------------- <br /> - <br /> 0 <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... sq.ft. ............................................................................... <br /> ri <br /> N O' <br /> O � 7 <br /> 3 <br /> 7 :w <br /> V7 <br /> O :6 <br /> : f 0 <br /> \x <br /> 'o <br /> _n <br /> � ° <br /> d <br /> La <br /> ;N <br /> to r -o co Z <br /> a n <br /> m, NQ O.<� 'O_ <br /> o cTt< C: ; S 0 ,9 <br /> OZ p V;:m m <br /> to 5' <br /> N, or <br /> :moo <br /> ........................................................................... ...................................... <br /> :po m <br /> i p <br /> Signature of Owner or Agent Date ?�° ` C <br /> Remarks ! 3 Sf,a.� C �it�� 3 � I—, T X i m <br /> �...... .................0..............................:" ...............................................:............................................ - <br /> ,6e wtT1� �n�ss�//• ...�.......-,�........-1ra.t.�er <br /> ............ ......... ...................... <br /> 3 /oec�i jt.Orw -Q :o ." <br /> .............................................................................................. ..................... <br /> : : <br /> ...... . . ..................... T <br /> Inspection Date ....................................... 0 0 0 0 o in m <br /> ZoningAdministra or 0 0 0 0 0 0 <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 />