Laserfiche WebLink
Burnett County Office of Zoning Administrator Ln o Z <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. ; :N- <br /> TO <br /> \ <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as •1 N o :V <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use c <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 <br /> cQc.✓... ... jY .............................. ,G.,� .�. O <br /> .... . .. ..... ........ ...................................... <br /> OWNER (please inti CONTRACTOR or SURVEY R or AGENT m _ m <br /> e/t <br /> ADDRESS s 93ti...�...... y� .... ....................A .............. a <br /> ........................................................................................... � <br /> ADDRESS . .......................................................................................... <br /> ADDRESS <br /> ........................................................................................... <br /> ............................................................................................ <br /> PHONE PHONE l <br /> ........................................................................................... . . ..................................................................................... <br /> PLUMBER WELL DRILLER <br /> ........................................................................................... .ADDR.........ES................................................................................. v <br /> ADDRESS S �' <br /> 0 o <br /> < i <br /> PHONEPHON..E....................................... . ...................... Z <br /> ............... <br /> DESCRIPTION 4. SanitaryFacilities: ° o ° <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details ..... . <br /> New Building .. O <br /> Type of Construction: No. Bedrooms ........ <br /> Addition .......... .................................................... Septic Tank Size Gals. .......... <br /> Sanitary .......... Size .............. ft. x .............. ft. <br /> .......... i < <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Soil Type ............................... Area ........................................... .................... <br /> r <br /> Mobile Home Slope ............................ .. ....... o <br /> ., <br /> Privy .......... 3. Use (describe exactly, 1 -family Pere. Rate ................................... <br /> Well home,garage, motel, etc.) Dry Well .......... <br /> Subdivision .✓•• Seepage Trench .......... <br /> Camping Unit .......... .................................................... Privy <br /> .................................................... .......... <br /> _______ Seepage Bed .......... <br /> ----------------------------------------------------------- <br /> Location of <br /> Proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched in Fig. A. Include road � (h <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- a <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING 5 <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. e <br /> -------------------------------------- o <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x ...........— ft. — ............................... sq. ft. ............................................................................... i <br /> SS 1 ti <br /> 0 <br /> �� 9 i�v ; JJ <br /> —t <br /> o <br /> T <br /> Z <br /> O <br /> 77 <br /> N <br /> M N m L N go Z <br /> M N < m <br /> n ITS < m ? B' f <br /> m EAa a< _ n <br /> No _, d D <br /> "O V7 < ,� m C m <br /> m _. m <br /> m <br /> o <br /> 0 <br /> m <br /> ..igna................................................................... ...................................... a <br /> Signature of Owner or Agent Date C <br /> X <br /> Remarks ................................................ - m m <br /> v <br /> .............................................................................................................................................................................. <br /> .141 II <br /> .......................................................................................................... <br /> t : <br /> .............. ............ ... ................. <br /> n � T <br /> n. <br /> Inspection Date ....................................... Zoning.... .... ....... . . i o o o u o m <br /> ' .�'✓ ,' c000gg <br /> Administ ar"tor ... .... . : <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures Involving sanitary facilities <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> this application before a permit will be issued. Do not purchase or Install a septic tank, do any plumbing or start any build- <br /> ing until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> with is found to exist. Changes in plans or specifications shall not be made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />