Laserfiche WebLink
Burnett County Office of Zoning Administrator d 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT a 3 <br /> TO THE ZONING ADMINISTRATOR'. The undersigned hereby makes application for a Permit for the work described and located as <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use c .QTc <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> .. ...�/� ..� ....................................... ..�� ... ....?Z .................. ........... <br /> OWNER (please print) CO TRACTOR or SURVEYOR or AGENT m <br /> a <br /> ADDRESS ADDRESS <br /> ADDRESS . .......................................................................................... <br /> ADDRESS <br /> ............ <br /> ........................................................................................... E <br /> PHONE ................................................................................ <br /> PHONi <br /> M � <br /> PLUMBER WELL DRILLER <br /> ........................................................................................... ............................................................................................ O <br /> ADDRESS ADDRESS m C) <br /> n O <br /> PHONE PHONE z H r- <br /> DESCRIPTION 4. Sanitary Facilities: ° o 0 <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details o <br /> New Building .......... Type of Construction: No. Bedrooms .......... l <br /> Addition .......... .................................I.................. Septic Tank Size Gals. .......... ,� <br /> Sanitary Size ft. x ft. ' <br /> .......... .............. .............. <br /> RillingiGrading .... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving Soil Type ..................... <br /> .......... ........................................... ............... r <br /> 0 <br /> Mobile Home .......... Slope .......................................... .* <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Well home, garage, motel, etc.) Dry Well .......... <br /> SubdivisionSeepage Trench .......... <br /> .......... .................................................... <br /> Camping Unit Privy .......... <br /> .................................................... <br /> Seepage Bed .......... <br /> --------------------------- <br /> - ----- — <br /> -- ---------- ------------------------------------------ <br /> - -- <br /> ------ --- ---- <br /> N <br /> Location of proposed structures and existing structures,well, sewage systems, roads,etc., should be sketched in Fig. A. Include goad � <br /> 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- O- <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING <br /> 0 <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. p' .� <br /> ------------------------------------------------------T i <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — sq. ft. .............................................................................., <br /> a <br /> 0 <br /> i o <br /> 0 <br /> ii <br /> 4 0 <br /> C � � <br /> O <br /> \N1 m <br /> I <br /> 37 N r L ur W Z <br /> m NL <br /> ( C`c <br /> P < <br /> m <br /> o <br /> Sl <br /> gnatu re of Owner r Agent e"i.............................. ...- ..D' y.... ...... 0 p <br /> o c <br /> X 77 <br /> Remarks ......................................................................................................................................................................... m . ' . . rTI <br /> ........................................................................................................... <br /> .......................................................................................................... ............... . . . . . <br /> . n <br /> T <br /> ^� m <br /> ............................ <br /> Inspection Date ....................................... .�<L::. :...1.............. <br /> � m <br /> Zoning Administrator : I" 0 8 0 0 0 o y <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilitms <br /> before construction can begin. In the case of sewerage disposal systerns, a copy of the percolation test must be attached to <br /> this application before a permit will be issued. Do riot purchase or Install a septic tank, do any phlmbinq or stall any build <br /> ing until a permit has been issued. A permit may be revoked if misrepresentation of any of the infonnaUon conveyed here- <br /> with is found to exist. Changes in plans or specifications shall not he made without approval of the Zoning Adm inistratoi . <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />