Laserfiche WebLink
Burnett County Office of Zoning Administr for <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT "3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work describe and .2 <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements o thec iLTi <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations fthe State of Wisconsin. <br /> ..........................................Y........................ ................................�Amz.................................... ....... is <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT <br /> ........... !.C...7Q.........a..9�..................... ....... - <br /> ......... . .................................................................................. ..... <br /> ADDRESS .. <br /> ADDRESS m <br /> ADDRESS. ........ 3.................................. ............................................... ....... t <br /> ADDRESS <br /> .. ,/5... ...i�., .. .... ;Ie..J..f................................... .PHONE..................................... ............................................ ....... \ \' <br /> PHONE <br /> • 1 <br /> ........................................................................................... r �) <br /> PLUMBER WELL DRILLER <br /> ........................................................................................... <br /> ADDRESS . ........ ...................................................................... ....... <br /> ADDRES....S 0 <br /> n o <br /> ........................................................................................... ........................ <br /> PHONEPHONE ................................................ ....... <br /> Z <br /> DESCRIPTION <br /> 4. Sanitary Facilities: - <br /> 1. Work: No. Bathrooms ' <br /> 2. New Building Details e11 <br /> ? <br /> New 6uliding ....� Type of Construction: No. Bedrooms N/`. ....... LU <br /> n <br /> Septic Tank Size Gals. <br /> Sanitary ...... M ,1 <br /> .......... Size ..../..Q..... ft. x .....Z..O.... ft. .. . —` <br /> Flliingf(irWing .......... Height..$....... Stories ...../........ 4a. Absorption Field Site: i <br /> Moving .......... Area ...2,010..5 .F...7............ Soil Type ............................ . rT <br /> MODIIa Home .......... Slope .................................. ..... . � <br /> Privy Pend. Rate ....... r m <br /> 3. Use (describeexactly,*1 -family � r <br /> Well .....I.... home,garage, motel, etc.) Dry Well */ � .... <br /> . ... <br /> Subdivision .......... Seepage Trench .. ....... o <br /> Camping UnitTO.......... Privy <br /> G......... <br /> Seepage Bed .. ....... jA' <br /> ------ ------------------------------------------------- 1 j <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. N <br /> 1� <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is local d at —FFL <br /> — <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersection. N <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. a <br /> ___________________________________________________________________ <br /> 5. Lot Si�ze�: S Fig. A. 6. Location: SOV SGOT4l.ffSp a( 1 <br /> x ............7fL . .../.J.r. ...w............ sq.ft. 46k .1yD.e...0 ...1QAAKC../ll..L(J.iCS ..... 2.wr, y—j <br /> Cou.ury Wi sG- <br /> N.86 36/ O�� E <br /> a s' °. <br /> 3 <br /> / \ <br /> I10—�� �ooae<.o inr ripU a <br /> OF 5 fOQAt5a: S/.L•� <br /> tis /.9q Ac <br /> 4e 40 <br /> 00 <br /> M to rnr D W map <br /> or o c c <br /> r m a n A n n <br /> v oui m m 5 5 <br /> ./ m 0 n m <br /> G o iwo D <br /> 0 <br /> a n o <br /> c <br /> .O <br /> . . ....... <br /> Signature of Owner or Agent % ' Date a . <br /> o ' <br /> N . <br /> Remarks <br /> m •• <br /> n w <br /> .................................................................................................................................................................................... ... � : o <br /> a . o <br /> 0 0 <br /> Inspection Date ....................................... ... 5 m <br /> .. ................. ................ ... <br /> 'Zoning Admin' ator 8 8 8 $ $ y <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary fac lities before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this appli ation before a permit will <br /> be issued. Do not purchase or install a septic tank,do any plumbing or start any building until a permit has been issued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans ors ecifications shall not be <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APP OVED. <br />