Laserfiche WebLink
Burnett County Office of Zoning Administrator d Ila 0 <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 located as < 7 ;O® <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use 1 c :DO <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 n <br /> a : <br /> m <br /> m. ........................................... . ...................Se. .. .............................................. - ° <br /> OWNER (please print) <br /> -� CONTRACTOR or SURVEYOR or AGENT a <br /> ....................................... : ..l.,...r .x.�.. ............................................................................................ z <br /> ADOR S ADDRESS <br /> � t. ............ ..........!........:.. ... .:......... .............. ADDRESS............................................................................ <br /> ADDRESS <br /> .. .......................................................................... ..... ....... ... <br /> PH..ONE.. .................................................................................... <br /> �\ <br /> PHONE <br /> PLUMBER WELL DRILLER is`• <br /> ........... <br /> ........................................................................................... .AD :! <br /> ADDRESS .......DR........................................................................ <br /> ESS <br /> n o <br /> ........................................................................................... ^. < <br /> PHONE ............................................................................................ z H .: <br /> PHONE � <br /> DESCRIPTION Sanitary Facilities: ° o 0 <br /> k ��v2' <br /> 1. Work: 2. New Building Details 1� -g No. Bathrooms �t / .......... <br /> New Building Ty of Consyruct' pig""� No. Bedrooms/ — .......... <br /> Addition .......... „(_;,Onti,Y¢f4e„ ..,.,... ., Septic Tank Size Gals. .......... <br /> Sanitary .......... , <br /> .......... Size ..../.. 'ft. x .�............ ft. <br /> Pilling/Grading ,,,,,,,,,, Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area Soil Type .................................... r <br /> Mobile Home .......... ........................................... Slope <br /> 0 <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate .. ' <br /> Well .......... home,garage, mol, a .1 Dry Well .......... <br /> Subdivision9 cSl.0 r++ri� Y'ou p4�o SeeP a e Trench <br /> Camping Unit .......... ..b.............. ./. . Privy <br /> ...........©0Zmr)r ,........................ (JJ <br /> Seepage Bed .......... O, <br /> -------------------------------------------------- <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should he sketched In Fig. A. Include road <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- <br /> section, show the intersecting highways and the setbacks required along them and at the intersection- CLEARLY LABEL EXISTING VJ < <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. (JJ o <br /> ---------------------—_-__--___---____--______----__----____------___- <br /> 5. Lot Size: Fig. A. 6. Locati n: 1_2 J <br /> Stj <br /> ................ ft. x .............. ft. — .i.Jl.l.L":�.:%............ sq.ft. ......../�.�!.J....J.. [ J... l° <br /> If a <br /> 0 �o <br /> 300 <br /> 0 qq _ <br /> 03�� <br /> z <br /> 0 <br /> v <br /> ry C N < N to N <br /> ur<„ C <br /> m n W <br /> 6 m c M <br /> m = m <br /> Z <br /> o <br /> 0 <br /> Signature of Owner or Agent Date �0 C <br /> Remarks : m <br /> T <br /> ry <br /> ........................................................................................................................................................................................ <br /> II <br /> ... ... ,fJ,/J ............................. <br /> ..................... <br /> : <br /> Inspection Date 7 L[-v`�.. "`��..................... E Vt p ....................................... . ....� ........Zonin dmmistrator r�:NOTE. A preliminary site inspection must be made and site approval granted on all structures involving sanitary facbefore construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attach <br /> this application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or stalt any hLI IId <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 Adm inistratol- <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />