Laserfiche WebLink
Burnett County Office of Zoning Administrator Cn v - -- 0 <br />E \ <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 H <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. a :d <br />�W� <br />................................i�2 �"...........:....'/ O (please print) CONTRACTOR or SURVEYOR or A ENT a <br />���..1,c.1..1.-Y ....................................................... <br />; <br />................. . <br />ADDRESS ADDRESS .+ <br />�n <br />...........................................................................'A-6*DRESS........................... <br />........................................................... <br />ADDRESS AD <br />........... <br />............................................................PHO—H—O—N...E.......................................................................�\ <br />PHONE <br />.......... <br />PLUMBER WELL DRILLER <br />.......... 0 <br />ADDRESS ADDRESS m G7 <br />n o <br />........... <br />.........................................................................PHONE ................................... o' <br />PHONE <br />Z H r <br />DESCRIPTION 4. Sanitary Facilities:° o ° <br />1. Work: 2. New Building Details No. Bathrooms o <br />New Building Type of Construction: No. Bedrooms CD <br />L <br />Addition Septic Tank Size Gals. <br />......••.. <br />Sanitary Size ft. x ft. ....•••..• <br />.......... .............. .............. <br />Filling/Grading Height Stories 4a. Absorption Field Site: <br />............ <br />MovingArea........................................... Soil Type.................................... <br />Mobile Home Slope.......................................... <br />o <br />Privy •.•...•... 3. Use (describe exactly, 1 - family Perc. Rate................................... <br />Well home, garage, motel, etc.) Dry Well <br />Subdivision Seepage Trench .......... <br />/.... <br />Camping UnitPrivy .......... <br />.............................................................. <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 />6 <br />setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- 0- <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 />0 <br />------------------------------------------------ <br />5. Lot Size: Fig. A. 6. Location: <br />................ ft. x .............. ft. — ............................... sq. ft.............................................................................. <br />Cnt <br />N 0 O <br />�a a� <br />KKIo <br />L C` ro <br />r -o rn Oo Z <br />0 3E <br />fDNQC`< cp <br />O Ut < ru <br />HM —m <br />Z Op D a <br />o n 70 <br />:tel o <br />CD <br />0 c <br />Signature of Owner or Agent Date 70 <br />X ...... <br />Remarks......................................................................................................................................................................... - . .CD <br />M <br />CD <br />.........................................................................................................................................................�........................... <br />Inspection Date....................................... ..�..�..... ......... o Uvi o Cn o P rn <br />Zoning Admi istrator �� 0 0 0 0 0 0 N <br />gOTE: 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 not 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 />vith 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 />