Laserfiche WebLink
Burnett County Office of Zoning Administrator C _ o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> + 0 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as y <br /> shown he ein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use _ c <br /> CD <br /> Ordina Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 n <br /> — m 0 <br /> N <br /> OWNER (p as pr' ) // CONTRACTOR or SURVEYOR or AGENT a <br /> ........ 7./........................................ <br /> D ......D R......ESS..... <br /> AD SS AD <br /> ADDRESS <br /> ADDRESS <br /> �d <br /> ........................................................................................... <br /> PHONE .................... <br /> .......... <br /> i• �/'_ �� PHONE <br /> ................................................ .......................................................................................... W <br /> PLUMBER WELL DRILLER <br /> 0 <br /> A <br /> ADDRESS .D...D..RES..S <br /> .... .............................................................................. <br /> cn L) <br /> o <br /> PHONE <br /> o � <br /> PHON.E................................................................................. + <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> 1. Work: 2. New Building Details No. Bathrooms <br /> .......... . <br /> New Building No. Bedrooms -0 <br /> ... ...... Type of Construction: <br /> dd .. CD <br /> ............. ..........jj........ .. Septic Tank Size Gals. <br /> Sanitary Size ... ft. x ... ..1...... ft. ......•••• <br /> p <br /> Filling .........• Height............. Stories ............... 4a. Absor tion Field Site: <br /> Moving Area Soil Type .................................... r <br /> .......................................... <br /> o <br /> Grading Slope .......................................... 0 <br /> Mobile Home ••••...••• 3. Use (describe exactly, 1 -family Perc. Rate ................................... U� <br /> Y ,gara e, motel, etc.) <br /> Privy h Dry Well <br /> Well .......... 1 Seepage Trench f <br /> 9 <br /> Subdivision .......... Privy <br /> U <br /> Seepage Bed .......... W <br /> Location of proposed structures and existing structures,well, sewage systems, roads,etc.,should be sketched in Fig. A. Include road C: <br /> CY <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 y <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> _ � o <br /> --------- — --------------------- ---- 3 <br /> 5. Lot Size: L4� z Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... sq. ft. ............................................................................... t` <br /> Cn <br /> CD <br /> 0 <br /> ?� o <br /> w <br /> N <br /> I(� 0 <br /> c.: -o <br /> m <br /> +` z <br /> 0 <br /> v <br /> CD <br /> m <br /> CD O sv CD QCZ <br /> o• C * m <br /> o :3 : <br /> cn n -i <br /> o <br /> 3 :cCD <br /> ....... ....................... .. . .......... .........r../.. c�— m <br /> Signature of Owner or Agent ate <br /> X <br /> m m <br /> Remarks ........................................................................................................................................................................ CD <br /> :'N. u <br /> ........................................................................................................ :G <br /> . ....... ..... <br /> n C'• 00000cnm <br /> nspection Date ....................................... �!.. ..�. .....:.... .g ........ ...... ........ ............. : I o 0 0 0 0 o m <br /> Zonin Administ for . . 0 0 0 0 0 o N <br /> OTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> ?fore construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> ris application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build- <br /> g until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> ith 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 />