Laserfiche WebLink
61/ <br />Burnett County Office of Zoning Administrator <br />APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <br />TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as <br />shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use <br />Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br />OWNER (please print) <br />-.1-3-02 ...13.a,�r.i iRD..... AA# -e, ..................... <br />A�cD?DRESS 1 <br />..ODRE..Th pa.•U..�..�...M11.......f��LJ.6.......... <br />............................................... <br />PHONE <br />.......................................................................................... <br />CONTRACTOR or SURVEYOR or AGENT <br />.......................................................................................... <br />ADDRESS <br />......................................................................................... <br />ADDRESS <br />.......................................................................... <br />PHONE <br />........................................................................................... <br />PLUMBER <br />........................... ...... ..... ...... ............. .................. —....... – <br />WELL DRILLER <br />ADDRESS <br />...................................................................................... <br />ADDRESS <br />............................................................................. <br />PHONE <br />...................................................................................... <br />PHONE <br />DESCRIPTION <br />1. Work: <br />New Building <br />Addition <br />Sanitary <br />4. Sanitary Facilities: <br />CD 0 z <br />0 � � o <br />rt <br />CID <br />� c <br />3 <br />°OC <br />y � G <br />N � <br />� � 7 <br />m � <br />:•Q9 <br />CD O <br />h o <br />0 <br />zr <br />0 0 0 <br />No. Bathrooms <br />2. New Building Details o <br />Type of Co tructio _._ '- No. Bedrooms .......... L <br />) \: CD <br />Septic Tank Size Gals. .......... �« <br />. ize .ZID 0..... ft. x .1.3.�...... ft. <br />.......... <br />Fillip /Gradin <br />Filling/Grading .......... Height ............. Stories ............... <br />4a. Absorption Field Site: <br />a: <br />``�: <br />Moving Area .......................................... <br />Soil Type .................................... <br />- : <br />r <br />Mobile Home .......... <br />Slope ................................ <br />Privy ,..,...,.. 3. Use (describe exactly, 1 -family <br />Perc. Rate ................................... <br />11), <br />Well he, motel, etc.) <br />Subdivision .......... ��gar <br />Dry Well <br />Seepage Trench <br />Camping UnitPrivy <br />.......... <br />�. <br />v` <br />Seepage Bed <br />-------------------------------------------------------------- <br />Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. Include road <br />1 <br />C <br />setback, side and back yard dimension and location and setback from all bodies of water. <br />If property is located at a highway inter- <br />Q <br />section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING <br />< <br />H <br />STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br />0 <br />---------------------------------- <br />— — — — — — --- <br />5. Lot Size: Fig. A. 6. Location: <br />QQ nn <br />.�e�...... ft. x../.I.7... ft. — ............................... sq. ft. ....��D..�.jLl�.. <br />C <br />CD <br />N <br />N 0 <br />O M <br />7 :N <br />7 <br />ra <br />q4. o <br />/D` o <br />vks40CD <br />V <br />o <br />6' J <br />d <br />:d <br />X cnr v* W)CW.CZD <br />0 6 < (Dd �< - m <br />C)O..i <br />p� <br />Si na ure o wn r... .............. 0 <br />M <br />g .e✓ or Agent Date o C <br />Remarks......................................................................................................................................................................... - M <br />CID <br />CID <br />Inspection Date.......................................acr/.. J............... o y+ o v o (A m <br />Zoning Administrator o 0 0 0 0 o N <br />VOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br />)efore construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br />:his application before a permit will be issued. Do riot purchase or install a septic tank, do any plumbing or start any build - <br />ng until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br />tvith 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 />