Laserfiche WebLink
r/ <br />Burnett Coun`ty Office of Zoning Administrator Cn W CD o <br />APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 3 <br />0 <br />TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < N -^ <br />shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use co m <br />Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br />J� CD...� <br />.T� � �............................................................ <br />OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a <br />...�..,,�,...�........................................................................................................... <br />D* RE S ADDRESSCD <br />.......... �!o..'..................................................................................................................................................... <br />ADDRESS ADDRESS <br />i' <br />....................� <br />............:....................................... ....................................................................... <br />PHONE PHONE <br />:.....%....�.� .............................................................................................................. <br />PLUMB R WELL DRILLER \ :� <br />ADDRESS ADDRESS 0 0 <br />......................... : <br />PHONE PHONE Z� <br />DESCRIPTION 4. Sanitary Facilities: ° o ° <br />No. Bathrooms �° <br />1. Work: 2. New Building Details o <br />New Building ... Type of Construc„tLo > No. Bedrooms z <br />^• h : CD <br />. <br />Addition LCZ"! Septic Tank Size Gals.< 3 <br />Sanitary ... .. Size .2 �..r ft. x ... ' D.... ft. <br />Filling/Grading .......... Height .......Lf.... Stories ..... I ....... 4a. Absorption Field Si : <br />Moving Area ......1.A �V ............. Soil Type .............�...... ; <br />Mobile Home Slope ........................�?.... y. T4......... <br />Privy Perc. Rate ................... e. <br />........ <br />3. Use (describe exactly, family. <br />""""" <br />Well —o , garage, motel, etc.) Dry Well <br />Seepage Trench <br />Subdivision.............................................................. A <br />Camping Unit Privy <br />Seepage Bed I� <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- i <br />section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING <br />STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br />------------------------------ ------------------- <br />5. Lot Size: Fig. A. 6. Location: <br />/^� ��'' ^^nn ff/n�,,pp / n <br />Q. ft. x ..Lr.. ft. — ....�.t` j. sq. ft. ............................ ^w <br />.................. .. .... ........!.Y.... <br />5� 1JR�<v <br />T <br />(D <br />Z <br />0 <br />C, m � .� W <br />CD <br />0 �a a� '- f <br />S. <br />7 ID <br />r� _. C w co <br />h <br />Z 0 0 Da a <br />O 3 : : : . a <br />o� m <br />...... . ..... ..... ................� C <br />a <br />r. <br />Signa re of Owner o Date <br />X <br />-nm <br />Remarks......................................................................................................................................................................... m . . . . . 0 <br />Co <br />....................................................................................................................................................................................... n <br />....................................................................................................... ..................... ....... �: . . . . . . <br />� ro co M <br />InspectionDate ....................................... '*���.` ............................... m <br />0 0 0 0 0 0 <br />Zoning Adm' istrator�J o 0 0 0 0 o N <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 />