Laserfiche WebLink
1 / <br /> Burnett County Office of Zoning Administrator �' o <br /> APPLICATION FOR SANITARY - LAND USE - BUILDING PERMIT 3 lel <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and q <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the 5 <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws no <br /> regul ions of the <br /> State of Wisconsin. » a <br /> ... b. ....... . s k I� ............s ...1.�.............................................I... ..... A <br /> OWNER Iple print) (/ CONTRACTOR or SURVEYOR or AGENT <br /> :h.. ./..x�......... ..�L.......�� .3..:�.............. .... ....... .. .. ..{.� �r ...... <br /> ADDRESS <br /> T / \ .......................... <br /> m <br /> ........................................................... <br /> ADDRESS ADDRESS ? TQ <br /> ........................................................................................... ................. . ... .. .. .... ...... ... ... .. .. .. ... .................. ...... Q <br /> PHONEtt i -�� ' <br /> ` •.e.� I h...A.................................................... PHON I .�� <br /> ... BER . . . .......................................................... ................... ...... �(JO :� <br /> PLU BER WELL DRILLER <br /> ......... ................................................................................. . . . ... . ...t v^� :S <br /> . <br /> ADDRESS ADDR •• •• I .1 � � �; T <br /> ........................................................................................... . ..................JJJ..���...................................................... ...... Z o .: <br /> PHONE PHONE......... ' <br /> � r <br /> DESCRIPTION 4. Sanitary Facilities: P o ro A <br /> 1. Work: 2. New Building Details No. Bathrooms ... ...... e rs <br /> New Building .... Type of Construction: No. Bedrooms <br /> Addition t= r 4-ti'. Septic Tank Size Gals. ... ....Q ;5. <br /> .......... .......... .... ............ . <br /> Sanitary ..'. .... Size ....k.Q.. ft. x ....7.d... ft. �. ..... EW i <br /> Fitting/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: i <br /> Moving .......... Area Soil Type ............................. ...... i r- <br /> ........ <br /> i <br /> ........................................... p <br /> Mobile Home Slope <br /> ................................... ...... <br /> .......... <br /> Privy 3. Use (describe exact) ,'1 :fami <br /> Perc. Rate ........................... ...... , <br /> Weil .......... home,garage, motel,e Dry Well .... Z <br /> Subdivision „ .. ....... o <br /> .................................................... <br /> Camping UnitPrivy <br /> .......... .................................................... 7 <br /> ------------------------------------------------- Seepage Bed <br /> -----/— <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fi . A. c � <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is local d 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. :S� 'A'� o <br /> J <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. - ............................... sq.ft. ....................................................................... ..... :� ? i <br /> n <br /> -YMJ I\ • � <br /> SZ�I �n o <br /> Po • �� Ik,3 � `0 " <br /> v <br /> 1 ' <br /> iia n�u �v( 5Lf�3a Vo <br /> . <br /> d <br /> �1Y � <br /> D rn -o CD rD mm -0 <br /> m. N0 < -' nm anA <br /> om o nm <br /> o`yo Z D - 1 <br /> u rn n A <br /> O a : <br /> 0 2 = In <br /> ...... ........................................... ...................................... <br /> Signature of Owner or Agent Date g <br /> Remarks ........> N!!w^!!.'."*�..� .�JC '%. .!!.!�'� ... '?!.. .... ............ ....�............... .... j <br /> ........................... .. / .r`...."`.......................... 19fla..................................................... ..... <br /> ............................ I ff/�. ay./�o ....................................... <br /> ...... ....... .......................... y: Nv ru S o ON <br /> T <br /> ® <br /> Inspection Date ...... Q .... m <br /> Zoning Administrato <br /> �iminary site inspection must be made and site approval granted on all structures involving sanitary fa ilities before construction <br /> �e case of sewerage disposal systems,a copy of the percolation test must be attached to this application before a permit will <br /> t purchase or install a septic tank, do any plumbing or start any building until a permit has bee i issued. A permit may be <br /> -entation of any of the information conveyed herewith is found to exist. Changes in plans or specifications shall not be <br /> ial of the Zoning Administrator. <br /> _WER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND AP ROVED. <br />