Laserfiche WebLink
Burnett County Office of Zoning Administrator o z <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 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 <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> p L m i�- O <br /> fl...P..yI..Rlel......�.0�L6 .'.L......µ.o.f ................ .:e..l!..R..C...G� ....................................... <br /> OWNER (please print) CONTRACTOR or SURV EVOR or AGENT C <br /> .. <br /> ...................... ............................................................................................ <br /> ADDRESS m <br /> ADDRESS <br /> o. ......... !.l.ff....Sr/'9 <br /> . .......................................................................................... <br /> ADDRESS ADDRESS <br /> �.7.7.-...:......`a... .................... .........................8 . .. <br /> ... <br /> . . PHONE........................... ................................................... •'c' <br /> PHONE <br /> ...... .. . . ....................................................................... <br /> PLUMBER WELL DRILLER <br /> ........................................................................................... ............................................................................................ ' <br /> ADDRESS ADDRESS <br /> o <br /> c <br /> PHONE <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> 1. Work: No. Bathrooms <br /> / 2. New Building Details No. <br /> New Building „V Typ¢j�f onstr coon: No. Bedrooms o <br /> .......... m <br /> Addition ......•... ,,..,n�� , rA Septic Tank Size Gals. .......... <br /> Sanitary ......... Size .... .. ft. x .a..7. ft. ... ...... <br /> FillingfGrading „ ,,,,,,,, Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving ........ . Area Soil Type .................................... r <br /> ........................................... <br /> Mobile Home Slope �_ ' <br /> .......... .......................................... <br /> PrivyPerc. Rate ................................... c <br /> .......... 3. Use (describe exactly, 1 -family ?C <br /> Well home,gara e, motel, etc.) Dry Well .......... <br /> .......... <br /> Subdivision ,,,,,,,,,, ,� 0 /'R fP Seepage Trench .......... �—� :'✓--� <br /> ................................ .. ................ <br /> Camping Unit Privy .......... <br /> .......... .................. . <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- <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING r ;q <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. `% <br />