Laserfiche WebLink
Burnett County Office of Zoning Adminifift for <br /> APPLICATION FOR SANITARY - LAND USE - BUILDING PERMIT3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and 'Z q ilP <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements o the m <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wisconsin. » a <br /> ..................... .. .. rrr�....Cx �.ern.................... ....... A <br /> OWNER (pleas <br /> or pri t CONTRACTOR SURVEYOR or AGENT <br /> ��..... . ........................ ....... .................................................... ....... d <br /> ADgAESS �c. ADDRESS <br /> �.,,� m i—�• `� <br /> .....L..l.;l,.l.�.....1..4�`..L.A'..J. ... !.:'.... I. ........... ........U.U..Ci�!> ,'!�y... - ...... .Q..�..�.. ....... E E <br /> 1 <br /> ADDRESS ADDRESS <br /> ........................................... ....... <br /> ........................................................................................... ......................................... t <br /> PHONE PHONE <br /> .... ...... ............................................................................... . . . . .............................................................. ....... <br /> PLUMBER WELL DRILLER <br /> ........................... <br /> ................................................................ .................................................................................... ....... O <br /> ADDRESS ADDRESS n <br /> P..H...O..N..E........ . . .... ........ ................ <br /> ....... . o <br /> n................................ ...... .................. ............ .P.. O ............. ...... ......... .................. ..... ..... <br /> ° <br /> DESCRIPTION 4. Sanitary Facilities: o .�r.- <br /> V6 <br /> 'e <br /> 1. Work: 2. New BuildingNo. Bathrooms <br /> Details """"' 'o <br /> New Building .......... Type of Construction: No. Bedrooms <br /> ' """" R <br /> AdditionSeptic Tank Size Gals. ....... <br /> .......... <br /> Sanitary .......... Size .............. ft. x .............. ft. . ........ <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area Soil Type ........................... ........ E c <br /> Mobile HomeSlope ................................. ........ .. <br /> .......... <br /> Privy .......... 3. Use (describe exactly,'I -family Perc. Rate .......................... ........ - <br /> 0 <br /> Well Dry Well home,garage, motel, etc.) Seepage Trench ..... o <br /> . ........ '• <br /> Subdivision .. ........................................... <br /> Camping Unit Privy . ........ <br /> Seepage Bed . ........ <br /> Location of proposed structures and existing structures well sewage systems, roads, etc. should be sketched in Fig. A. rIc c <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is loca ed atV� <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the interse ion. -9—) `— <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. ___ ; <br /> __________________________________________________________________ <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. . ............................... sq.ft. ..................................................................... ......... :� \ <br /> y <br /> v6 <br /> 0 <br /> 0 0. <br /> �� a I� w <br /> a <br /> k <br /> 1 T <br /> Z <br /> O <br /> :A <br /> W <br /> J <br /> O <br /> N <br /> M v (nr Dmm no <br /> M cr < > > n = m <br /> m n —' nm any <br /> a <' dc0 � 33 <br /> 0 (O f0 <br /> 0 <br /> o n <br /> 2 M0 <br /> o m <br /> M <br /> ... . .ignatur...... .. ....of....O...w..ner.. ..or.... ...A..ge..nt D. ................................. ...................at................... <br /> Se e � g <br /> H <br /> Remarks n <br /> N <br /> O O <br /> ......................................................................................................... <br /> ....................... ...... ..... . .............. O <br /> ..... N O] N N T <br /> Inspection Date ....................................... .... .. . ...,.....� v, v, v, O c u, m <br /> Zoning Administrator 8 8 8 8 8 8 W <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary f icilities before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this apr licalion before a permit will <br /> be issued. Do not purchase 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 misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans oi specifications shall not be <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND A PROVED. <br />