|
Burnett County Office of Zoning Administratoro 0
<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 0.
<br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use [ W
<br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a a
<br /> .............. �' c
<br /> .leas....... .... ../.� ....... ...... ... ............T-0R-. -r--S....VE-Y- ............... T............................... N
<br /> J
<br /> O���N�ER (please print�Z, .y � CONTRACTOR or SU RVEVOR or AGENT a �
<br /> !•r .� ... G1 Syoa —
<br /> ............ .. . .......................................................................................... o-
<br /> ADDRESS
<br /> m
<br /> .................................................................. ........................ . . ...... . ...............................................................................
<br /> ADDRESS ADDRESS
<br /> ........................................................................................... .PHONE...........................................................................................
<br /> PHONE
<br /> i
<br /> PLUMBER WELL DRILLER -
<br /> ..........
<br /> ...........................................................................................
<br /> ADDRESS . .....DRESS...........................................................................
<br /> AD
<br /> 0 0
<br /> n o
<br /> ........................................................................................... ..PHONE............................................................................... 17
<br /> ........... :Z N'
<br /> PHONE
<br /> DESCRIPTION 0
<br /> 4. Sanitary Facilities: ° o °
<br /> 1. Work: 2. New Building Details No. Bathrooms
<br /> New Building No. Bedrooms 0
<br /> .......... Type of Construction: '0
<br /> Addition .......... .................................................... Septic Tank Size Gals. ..........
<br /> Sanitary .......... Size .............. ft. x .............. ft. .......... E
<br /> Filling/Grading ,,,,,,,,,, Height............. Stories ............... 4a. Absorption Field Site:
<br /> Moving
<br /> Soil Type ....................................
<br /> .......... Area ........................................... r
<br /> Mobile i
<br /> Home .......... Slope .......................................... o .« .
<br /> Privy ....,...., 3. Use (describe exactly, 1 -family
<br /> Parc. Rate ................................... 3
<br /> Well ,,,,,,,,,, home,garage,motel, etc.) Dry Well .......... F iw
<br /> Subdivision , Seepage Trench
<br /> .......... n "C
<br /> n
<br /> Camping Unit ,,,,,,,,,, Privy .......... K
<br /> ....................................................
<br /> Seepage Bed ..........
<br /> -------' -- - ------------------- u
<br /> 01
<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 C <
<br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. t vl
<br /> 0'
<br /> ________
<br /> 0
<br /> 5. Lot Size: Fig. A. 6. Location:
<br /> ......... ft. x .............. ft. . ............................... sq.ft. ............... °
<br /> N o.
<br /> G o
<br /> Ur �
<br /> =j v °
<br /> — � s
<br /> inta
<br /> 0
<br /> a
<br /> }
<br /> � Na; Z
<br /> M m m
<br /> D on d c_
<br /> m
<br /> Z O N D a m
<br /> 0 ° a '
<br /> in rz m 3
<br /> G� n =4
<br /> ........................................................................... .......................... ...........
<br /> Signature of Owner or Agent Date °
<br /> X
<br /> Remarks ......................................................................................................................................................................... rn
<br /> A �J C7m
<br /> ........................................................................................................................................................................................ fA
<br /> .. . . .
<br /> :O
<br /> ...................................................................................................... ............. lQ
<br /> . . . .u, . u.
<br /> Inspection Date ....................................... 8 m o N,
<br /> T
<br /> ZoningAdmiRstrator t p 8 8
<br /> 08 8 8 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 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 Ile made without approval of the Zoning Administrator.
<br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED.
<br />
|