Laserfiche WebLink
Burnett County Office of Zoning Administrator d o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT . o <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 m o :d\ <br /> Ordinance, <br /> Sanitation Coodems/�taan�dwititha.l,lll other applicable County Ordinances <br /> and the laws and regg/uf�latio�ns of tt/he State of Wisconsin. 3 0- <br /> 6 <br /> d <br /> n <br /> A <br /> OWNER (please nt) CONTRACTOR or SURVEYOR r AGENT a `; <br /> ..... . . . ...Vg <br /> ............................................................................ .AD.....D. . .RESS................ <br /> ................ <br /> ........ <br /> .... <br /> ............ <br /> .............. <br /> .......... a <br /> ADDRESS <br /> ............................................................................................ ?A\ <br /> ADDRESS ADDRESS <br /> ........... <br /> PHONE................................................................................ .PHONE..................................................................... <br /> :\ <br /> ........................................................................................... .WE... ........D.RI....LL....ER....................................................................... `?�� <br /> PLUMBER LL <br /> O <br /> ADDRESS ADDRESSeD <br /> 0 o <br /> ........................................................................................... ............................................................................................ o' <br /> PHONE PHONE Z H r <br /> DESCRIPTION 4. Sanitary Facilities: <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details '.'.."'.. o <br /> New Building <br /> .......... Type of Construction: No. Bedrooms .......... I I <br /> Addition ......,,.. Septic Tank Size Gals. .......... i <br /> Sanitary .......... Size ft. x ft. """"" <br /> Filling/Grading .......... Height............. Stories ...........I... 4a. Absorption Field Site: i <br /> Moving ........ Area ........................................... <br /> Soil Type ....................................... <br /> MobileHome Slope .............................. . .... ... <br /> .......... r0 <br /> Privy ...••,,,,, 3. Use (describe exactly, 1 -family Perc. Rate ................................... i <br /> Well .......... home,garage, motel, etc.) Dry Well .......... <br /> .. i <br /> Subdivision ✓ Seepage Trench ........ E f•. <br /> Camping Unit Privy .......... <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 c i� <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- a C <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. p' <br /> --------------------------------------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: �--. <br /> ................ ft. x .............. ft. . ............................... sq.ft. . ............................................................................. < '� <br /> � Q,�� � s� <br /> J y <br /> x> ✓ m <br /> ,J co �• iN <br /> 1 -R <br /> �J Z <br /> O <br /> d <br /> J <br /> m <br /> ( 1 <br /> m c a < d c m <br /> n rT � < F <br /> m Nd <br /> "O C '� _ m � m � <br /> V1 < w . [ m <br /> m , _. m <br /> o �. o <br /> 0 <br /> 20 yoar 70 <br /> m <br /> ........................................................................ .11..-.x.-ef!.... ° <br /> Signature of Owner or Agent Date <br /> X <br /> Remarks ............................................................. T m <br /> m <br /> » , <br /> ........................................................................................................................................................................................ <br /> ......................................................................................................... ..........................9.. ................ <br /> O .\ts, <br /> f .... . 8 o noNo � "t <br /> Inspection Date ....................................... alT.l:eo. ....(........... m <br /> Zonin Ad trato ................ S 8 8 S 8 S y <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 riot 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 />