Laserfiche WebLink
�y112�2�, <br /> Burnett County Office of Zoning Administr itor <br /> APPLICATION FOR SANITARY - LAND USE - BUILDING PERMIT 3. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and '� — <br /> o <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements o the a c <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations of th tate of Wisc nsin. a <br /> f — m <br /> o..K..4.../.. ......... .....��0...LY.S.......................... �y <br /> OWNER (please print( CONTRACTOR or SURVEYOR or AGENT <br /> .. ., <br /> L4 <br /> AD <br /> » <br /> .............. ... ..... . .... .. .................................................................................... ....... y i �' .� <br /> AD <br /> pDRESS / ( ADDRESS <br /> R.(.�Y.......................................... <br /> ./..:.... 7.C.v�.s� <br /> ADDRESS ADDRESS <br /> 1 i <br /> PHONE_ PHONE' <br /> K o� <br /> .........................................................n r ...... <br /> PLUMBER WELL DRILLER W <br /> O :o <br /> ADDRESS ADDRESS aC II <br /> ........................................................................................... <br /> .P.. .......................................................................... ....... O » <br /> :A <br /> PHONE HONE....... Z H r <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms '— o <br /> New Building Type of Constr tion: No. Bedrooms .. ....... <br /> Addition ••••••,,,, �,,,;'l,t,li.{;F•,.,,.•,,,,,,,, Septic Tank Size Gals. ...S.o <br /> Sanitary .. .... Size .............. ft. x .............. ft. .......... .� <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area ........................................ Soil Type .................................... o i <br /> Mobile HomeSlope .......................................... » <br /> .......... <br /> Privy .......... 3. Use (describe exactl '1 ffamil Perc. Rate .......................... ........ R� i <br /> Well .......... home,garage,motel, etc.) Dry Well . ........ i <br /> Subdivision Seepage e Trench <br /> o <br /> .......... <br /> .................................................... <br /> Camping Unit .......... .................................................. . Privy . . ...... <br /> • Seepage Bed <br /> ------------------------------------------------------------------- I� <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fi . A. IT <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is loca ed at : a <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersec ion. <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o <br /> ------------------------------------------------------------------- — i <br /> 5. Lot Size: Fig. A. 6. Location: r� <br /> ................ ft. x .............. ft. — ............................... sq. ft. ...................................................................... ........ �r <br /> J <br /> B 0 <br /> 0 <br /> O <br /> o <br /> 0 <br /> 0 <br /> i a <br /> : T <br /> Z :Z� <br /> O <br /> m <br /> J <br /> tt. a <br /> m :na C a 0 DIP1 <br /> 0HQ < > > 0 � . m <br /> m, "nom ' o. a nn 70 <br /> D o 5. : m C <br /> O (O m <br /> O MOD <br /> n ; In <br /> 20 m <br /> � C J <br /> . <br /> ...........a.................. N L <br /> t. <br /> m <br /> Signature Owner or Agent Date <br /> Remarks .........!I..,N!!..CQ7!:: -.f'......................................................................................................................... ..... m c- . <br /> 0 <br /> 0 <br /> 0 <br /> ........................................................................................................./.. ................ .9....................................... ..... <br /> �I <br /> Inspection Date .. .7..- �.............. �.... . .. ... .�.... ...... .. .. ..... ........ ..... v, . m o o u, m <br /> Zonin ; dmr l tratorJr A o S $ o o N <br /> NOTE: A preliminary site inspection must be made and site app val granted on all structures involving sanitary f ilities before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this app ication 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 beel 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 shall not be <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />