Laserfiche WebLink
Burnett County Office of Zoning Adminis,rator &n <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 0,� <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and to ted as » °n <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Lad Use m e <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin, 3 p_ <br /> 1 Plf E <br /> . . ................... ....................................... h t� <br /> OWNER IPIease Print) .!!!',v.................................... ......... m <br /> ._ CONTRACTORor SURVEYOR or AGENT ° <br /> A ......... . <br /> 5...! .R.......R..T 2 130 }( 27 2 <br /> DDRESS ............... . ................. <br /> ADDRESS.................................................................. ......... -- <br /> Ar Nave was C s�� 0 <br /> ..................................................... Y <br /> ADDRESS ..... ............................................................................ ......... <br /> q ADDRESS <br /> .......................!...7............................................... <br /> PHONE . ....................................................... <br /> PHONE ......................... ......... :MM • <br /> .............................................................. <br /> PLUMBER . ......................................... ' <br /> WELL DRILLER ................... ......... <br /> ............................ ..............................ADDRESS . ................................................................................ ......... <br /> • m <br /> ADDRESS � • <br /> m 0.................................................... <br /> PHONE .................................. . .PHO....NE...... ....................... . ^.. .............................................: 1; <br /> ...... o . <br /> DESCRIPTION Z n� <br /> 4. Sanitary Facilities: P g oI <br /> 1. Work: / 2. New BuildingDetails No. Bathrooms v <br /> New Building v <br /> TY r No. Bedrooms ° <br /> Addition Septic Tank Size Gals. . . ..... <br /> .......... .................. .................. ..�...... <br /> Sanitary Size ..,.3. ft, x ... <br /> ,4•.., <br /> FIIIing/Carading Height..... Stories ........�..... 4a, Absorption Field Site: <br /> Moving Area <br /> .. ......1x ...................... Soil Type ............................ ...............Mobile Home ........ Slope .......................Privy ......... <br /> .......... <br /> rO <br /> 3. Use (describe exactly, 1 -family Perc. Rate .......................... ........`•F� i '� <br /> Well home, era e,.Motel, etc.) Dry Well C� <br /> Subdivision /� /� "••••• • <br /> .......... .... .....t4k°�.Q. .............. Seepage Trench <br /> Camping Unit """"' <br /> .......... Privy <br /> ----------------------------------............................... Seepage Bed <br /> Location of proposed structures and existing structures, well, sewage systems, roads etc., should be sketched in Fig A. IncludE road m (� <br /> setback, side and back yard dimension and location and setback from all bodies of water. if <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY d LABEL EXIS ZING a <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> __ _____ -. P <br /> - ________ <br /> 5. Lot Size: Fig. A. 6. Location: S <br /> . <br /> 34-7 <br /> ft.ft. x ..3.bft. — ............................... sq.ft. ...................................................................... . K � <br /> e' <br /> 011 <br /> r� a <br /> UO L N a <br /> 1 0 P, W <br /> o <br /> r b `/ D <br /> f�EquSr�' i o <br /> �'D Z <br /> • �� Y, C' <br /> f—R Gr/c 61 1`�v Ap a F a m <br /> n NJ ¢� 0 E F <br /> (P —.C m — m <br /> n : ,2ro c <br /> Z Co. . <br /> D a <br /> .. . .. . . ................................ f <br /> 71�,a4iur�otw�e;"Or Agent " "' """""""'•'•••• <br /> m <br /> Date ; <br /> C <br /> Remarks ...................................................................................................................................................................... .. X <br /> 70 <br /> A m <br /> .............................................................................................................................. A O <br /> ........................6........... <br /> Inspection Date ...... <br /> •....•.. . . . . ...... �:M1 .. J U1 <br /> Zoning Administrat r 0: g g g g ' 8 <br /> VOTE: A preliminary site inspection must be made and s t approval granted on all stru tures involving sanitary faciiitie, <br /> tefore construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must it attached to <br /> his application before a permit will be issued. Do not purchase or install a septic tank, do any Plumbing or start any h d to <br /> ng until a permit has been issued. A permit may be revoked if misrepresentation of any of the in m anon conveyed here <br /> vith is found to exist. Changes in plans or specifications shall not be matte without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE A D APPROVED. <br />