Laserfiche WebLink
ON GOMPUTER/SCANNED <br /> Burnett County ii <br /> Office of Zoning Administrator C - --1 z <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMITo <br /> 3 0 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as � � 7 <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett Count Land Use - o <br /> 9 g ti <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin.l ' vCD <br /> ................p°..�� .......... oe�A VSIe� e .... <br /> / <br /> OWNER lease print ' • Te /� _ <br /> �5� ) Ne, 0 <br /> CONTRACTOR or SURVEYOR or AGENT """"' `= <br /> CD <br /> ADDRESS .............................. <br /> ... ............................................................................. � <br /> ADDRESS Q <br /> .................................. <br /> ADDRESS ......................................................... � � . <br /> ADDRESS . <br /> PHONE ......................................................... \ • <br /> ......................................................................................PHONE <br /> PLUMBER ...........WELL DRILLER <br /> ADDRESSAD.....R. EES—S—S............................................................................. <br /> D <br /> 0 <br /> ........................................................................ : o <br /> °HONE PHONE � 0 <br /> DESCRIPTION N <br /> r <br /> 1. Work: 4. Sanitary Facilities: R o o <br /> New Building <br /> 2. New Building Details No. Bathrooms k <br /> Type of Construction: No. Bedrooms <br /> Addition <br /> Septic Tank Size Gals. <br /> Sanitary p m <br /> Size .... .. .. ft. x ...3 ... ft. <br /> Filling/Grading ....I..... r, <br /> Height............. Stories 4a. Absorption Field Site: <br /> Moving Area Soil Type <br /> Mobile Home r— <br /> Slope o <br /> rivy 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> .......... . . : <br /> Well home,garage, motel, etc.) Dry Well <br /> Subdivision •••••••••• �'�•� <br /> �:&RA.f:.4.................. Seepage Trench :J <br /> Camping Unit """"" <br /> Privy <br /> ------------------------------------ Seepage Bed <br /> -------------------- <br /> ocation of proposed structures and existing structures,well,sewage systems, roads etc.,should be sketched in Fig. A. Include road <br /> aback, side and back N yard dimension and location and setback from all bodies of water. If property is located at a highway inter- c <br /> ction, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING <br /> rRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> ------------------ <br /> ------------------- <br /> -------------------------------- <br /> Lot Size: Fig' Location:A. 6. Loti <br /> ................ ft. x n <br /> f41O,�nfr /• 8 rt�r�s <br /> a}� Rt�ers .. . .......5..a................ • <br /> m <br /> N p' <br /> o <br /> -D : <br /> cn <br /> 0 <br /> N <br /> -n w <br /> co y� <br /> z c <br /> o <br /> Iv M. Cz <br /> 7 fD 7 0 <br /> C M <br /> z o o' • CL >p <br /> amUT <br /> m <br /> nature of Own8, gent ...................... ...... , C <br /> Date <br /> 70 <br /> tarks ................................... x <br /> .:..:................................................................................................................................. - m <br /> CD <br /> ............................................................................ .................................................................................................... <br /> ...................................................................................................... <br /> section Date ...............................:....... /.... .. y•� c N M <br /> .. ..... ................................ •� O Cn O CT.m <br /> Zoning Ad istrator :� : 0 0 0 0 o y <br /> 'E: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities' <br /> re construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build- <br /> until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> 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 />