Laserfiche WebLink
Burnett County Office of Zoning Administrator 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. <br /> 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 Lad Use e <br /> Ord nice, Sanitation Code, and with all other applicable County Ordinances and the lawsg <br /> regulations of the State of Wrsc nsin. a i <br /> l I <br /> I��'r .. r. . ....... . . .... ... ....� 1. �. r?a..... �� �. ) .................... .......1........ <br /> �o <br /> IT <br /> OWNER (plea e print) CONTRACTOR or LSteRVEYOR or AGENT a :� <br /> ..\.1.4..C.1. <br /> Ey _ <br /> ........................................................................................... . (..... .:.F/.L� .,:...................................L........ <br /> ADDRESS A...DIDR1 �SS ( ....jJ ::.. � ..... ......... i . r <br /> ADDRESS ADDRESS —� <br /> l r� <br /> ........................................................................................... .P..HONE...............................................................................i......... <br /> PHONE <br /> . ................................................................................ ......... <br /> ........................................................................................... WELL DRILLER <br /> PLUMBER <br /> O <br /> 'I` <br /> ........................................................................................... .A...D..D...R...ES...................................................................... <br /> ADDRESS S m <br /> or o <br /> ........................................................................................... . ................................................. .................... <br /> ON .........L........ � o r: <br /> PHONE <br /> PHONE <br /> Z 0 �t <br /> DESCRIPTION 4. SanitaryFacilities: ° o ° <br /> oms """"'th <br /> Baro -O <br /> 1. Work: 2. New Building Details No. I i o E <br /> New Building .......... Type of Construction: No. Bedrooms { '' i <br /> Septic Tank Size Gals. .......... » <br /> Addition .......... .................................................... < <br /> Sanitary .......... Size .............. ft. x .............. ft. .......... <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area Soil Type .................................... o <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 /> .......... .................................................... <br /> Camping Unit Privy .......... <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 e <br /> Q <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highw y inter- d <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 /> ---------------------------------------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... s4.ft. ....................................................................L........., S <br /> 0 <br /> N <br /> DD <br /> I � o <br /> rips <br /> ti- <br /> Z <br /> ro <br /> 1 <br /> l' 7J r v m W Z <br /> m ao.1 <br /> ry m <br /> -o < a <br /> ro <br /> � D n rt <br /> Z oip n � S <br /> �J am 5 <br /> _ !Jc <br /> l5a rr <br /> 0 <br /> SC <br /> ..ignatu...... r. ........of.......w..ner......or....Agent... e"i.............................. ................D..ate. ....:. :.......... o <br /> e Oj — <br /> X <br /> T R <br /> Remarks ................................................................................................................................................................ ........ C <br /> � <br /> v <br /> ............................................................................................................................................................................... ........ : . : . . : <br /> C <br /> Inspection Date ......... ....vv ,4{.., r1... < 1..,.,.-z, n...... rf <br /> ......... ..... ....... ... .4':�i 1'� l,'.� / 4h Ti 1, 1 t 'cc <br /> Zoning Administr for "y, `— :Cc S S S S S s r/ <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures �nvolving sanitary facilities <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolaLon 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 Ithe Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICEI AND APPROVED. <br />