|
Burnett County Office of Zoning Administrator Ln - O o
<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 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 c sli
<br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a
<br /> . ... . , ............................................. ,� .. :.... ,.. w. N d
<br /> OWNER (p a print) CO TRACTOR or SURVEYOR or AGENT m r�
<br /> . .9...,..../
<br /> .................................................... d
<br /> ADDRESS ADDRESS ..
<br /> LJ ...... :.ysy
<br /> ADDRESS ADDRESS
<br /> PHONE
<br /> PHONE. ...............................................................................
<br /> .W....ELL DR..........I........LLER.....................................................................
<br /> PLUMBER
<br /> O
<br /> .. . . . . .............................................................................. ........ .SS... ............................................................................ m
<br /> ADDRESS ADDRE
<br /> n O
<br /> PHONE PHONE
<br /> DESCRIPTION r
<br /> 4. Sanitary Facilities: ° o
<br /> 1. Work: 2. New Building Details No. Bathrooms '
<br /> New Building ,,,,,.,,,, Type of Construction: No. Bedrooms .......... a '
<br /> Addition .......... .................................................... Septic Tank Size Gals. .......... i i
<br /> Sanitary .......... Size .............. ft. x ft. .......... n
<br /> ..... ........ o
<br /> FillingfGrading .........• Height............. Stories ............... 4a. Absorption Field Site:
<br /> a:
<br /> Moving .......... Area ........................................... Soil Type .................................... o
<br /> Mobile Hama .......... Slope .........................
<br /> .............. ..
<br /> Privy ,,,,,,,,,, 3. Use (describe exactly, 1 -family
<br /> Perc. Rate ................................... n
<br /> Well .. home,garage, motel, etc.) Dry Well .......... 14
<br /> Subdivision . ...... Seepage Trench .......... u i
<br /> .......................................... .........
<br /> Camping Unit ,,,,,,,,,, Privy ..........
<br /> .................................................... Seepage Bed r
<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 highway 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. . ............................... sq.ft. ...............................................................................
<br /> s
<br /> C2 S�
<br /> w
<br /> 0
<br /> N T
<br /> z
<br /> 0
<br /> M
<br /> d
<br /> m
<br /> Ut
<br /> n r u CC N to z
<br /> C d m j C N
<br /> N
<br /> mm
<br /> O O p
<br /> on
<br /> O
<br /> :'V O
<br /> �� 0 m
<br /> €G
<br /> ........................................................................... ./.�.:/..�....................... o C
<br /> Signature of Owner or Agent Date
<br /> RemarksP.�!!d°2r,;.', ..•.....��.`..�•2Y 6 -n m
<br /> ..... ....... .....................................................................................................................
<br /> ........................................................................................................................................................................................
<br /> ...................................................................................................... . : : : : :
<br /> ..... ......................
<br /> ..... .... ............................
<br /> /9 N , N m
<br /> Inspection Date ....................................... /r.�..?7: �.......:..... ....:..Q!p. .. ......... ... u U o 8 o v,
<br /> Zoning Adminis ator 8 8 8 8 8 8 vmi
<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 be made without approval of the Zoning Administrator.
<br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED.
<br />
|