Laserfiche WebLink
Burnett County Office of Zoning Administrator 10 <br /> APPLICATION FOR SANITARY - LAND USE - BUILDING PERMIT <br /> 1 0 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and 12 <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the E i <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws ind <br /> regulations of the State of Wisconsin. <br /> CL <br /> Rq.w�K�a.k................................. ....... <br /> ...... ..... <br /> 'ii��E�OR or SUR��V&�'O­;'Z�.......... <br /> CON <br /> .7 <br /> a <br /> r4 <br /> ADDRESS ADDRESS <br /> .......If ......... ...... ...................... ...... o' "b� <br /> .............. <br /> ADDRESS ADDRESS <br /> -2 C' <br /> 3.21........................................ ................. ................................................................. ...... <br /> PHONE <br /> .......... .......... ................ .......................... 'W-E, ...L...D'R"I'Ll"E"A" ........... .................. .......... ........... 71�' <br /> ...........*......*.............. ............................... ....... 'A"D'...D'R"'E'S"S'.............-.......... ...*..................*................... C) <br /> 0 <br /> 0 <br /> 0............*................. ...... ........--...... 'P-H-0-N-*E* ............. ......... .....................-.......... .......... ...... Z <br /> DESCRIPTION 4. Sanitary Facilities: <br /> 0 <br /> 1. Work: 2. New Building Details No. Bathrooms <br /> 0 <br /> N"Building Type of uction: No. Bedrooms ...... <br /> Addition ........W��....4.!:�.................... Septic Tank Size Gals. ... ...... <br /> sanitary .......... size ...2�....... ft. x ...:�q...... ft. ... ...... <br /> FillinsilGrading .......... Height 5 Stor, I 4a. Absorption Field Site: <br /> Soil Type .................... <br /> .......... '.'& .- - �: <br /> Moving Area ................ ....... ...... r; <br /> Mobile Home Slope ................................... ...... <br /> .......... <br /> Privy <br /> .......... 3. Use (describe exactly, 1 -family Perc. Rate ............................ ...... <br /> Well .......... home garage, motel,etc.) Dry Well ... ...... a <br /> subdivision Z <br /> Seepage Trench ... ...... <br /> 0 <br /> .......... ... J. ..kmmc ................. <br /> Camping Unit .......... Privy .......... <br /> ............................ ....................... <br /> Seepage Bed ......... 573 <br /> ----------------------------------------------------------------------- <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched i <br /> n Fig. A. <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is locat id at <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersect on. <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. 0 <br /> ----------------------------------------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ft. x .............. ft. — q <br /> .......... ....... <br /> ................ ................. sq.ft. ..................n?� ...t�1(.... ...................... <br /> !j" <br /> &1,1.rk t <br /> 0- <br /> 0 <br /> 0 <br /> 0 <br /> M <br /> r) OM <br /> > <br /> m W 0 0 <br /> . n 0 �- . m <br /> M co 5 <br /> 0 M Q0 <br /> o > <br /> M <br /> A m <br /> ............................. ..........t.... .................... <br /> -�tur, <br /> fl��nr ate <br /> Remarks .................................................................................................................................................................... .... M � <br /> ..........................................................................................................................................I........................................ .... <br /> ...............................................................................................".... ...I........................................ ..... .... . . <br /> M <br /> Inspection Date ....................................... m <br /> z oning tor' <br /> ... ...... . �:�m'i'ni ii� ...... <br /> NOTE: A preliminary site inspection must be made and site ap roal g on all structures involving sanitary fac ilities before construction <br /> can begin, In the case of sewerage disposal systems,a copy of the percolation test must be attached to this appli ation 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 beer issued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or specifications$hall not be <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APF ROVED. <br />