Laserfiche WebLink
Burnett County Office of Zoning Administrator W �0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3 0 <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 m m � <br /> Ordinance, Sanitation Code,and with II other applicable County Ordinances and the laws and regulations of-the State of Wisconsin. 3 a <br /> I •• �• i CONTRACTOR or SURVEYOR or GEN <br /> .l. r ��. �r A ✓ ✓i / J/ter ! �� t... �...5. ...s.. .. C <br /> �' <br /> 4••'•••• a. T I <br /> OWNER (please Holl <br /> ....... ....... ............................ /. . . l .✓ o. -a � '� <br /> .... ...... :............ <br /> ....... ....... F. <br /> . .......................... ADDRESS <br /> ADDRESS - ° - <br /> ........................................................................................... <br /> ............................................................................................ <br /> ADDRESS ADDRESS Tti °L <br /> .................................................. <br /> ........................................................................................... . . . ................................. <br /> PHONE PHONE •� ;: <br /> ........................................................................................... WEE"L..L D....RILL— 'L ..ER....................................................................... <br /> PLUMBER <br /> ................. .............. . . A ..................................................................................... <br /> ............. ........ ...... ............................... '"''D _. '.:`.. <br /> ADDRESS ADDRESS 0 0 <br /> PHONE................................................................................ . ................................................................................ ' 0 <br /> PHONEZ 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 .......... a <br /> Addition Septic Tank Size Gals. <br /> Sanitary Size .............. ft. x .............. ft. .......... '\ <br /> FillingtGrading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving Soil Type .............................. <br /> Area ......................................... ...... i r ..a <br /> Mobile Home .......... Slope .......................................... <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Well home,garage, motel, etc.) Dry Well .......... <br /> Subdivision Seepage Trench .......... <br /> Camping Unit .......... ..................:................................. Privy .......... <br /> .................. .... Seepage Bed <br /> _____ __-----_ ---------------- ------_----__------- N <br /> Location of proposed structures and existing structures,well, sewage systems, roads,etc., should be sketched in Fig. A. Include road Q' <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- �- <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. o <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. . ............................... sq.ft. ............................................................................... <br /> / A <br /> N O <br /> / <br /> T :4, <br /> 1 <br /> rt. <br /> d <br /> i� <br /> m m <br /> fZ <br /> a cNn c: <br /> oam : am am <br /> 0 a <br /> ob' . ge <br /> 64 <br /> m <br /> ............... i`l0 I C <br /> ........................................................................... ................ba"i . <br /> Signature of Owner or Agent Date " _ ti <br /> X <br /> Remarks ......................................................................................................................................................................... m <br /> M <br /> t» d <br /> ........................................................................................................................................................................................ 11 <br /> ........................................................................................................................................................................................ . . . . . . T <br /> ' �' ^1 ao1'nomm <br /> Inspection Date ....................................... <br /> Zoning Administrator 8 8 8 8 8 8 v <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 We made without approval of the Zoning Administrator, <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />