Laserfiche WebLink
r. <br /> Burnett County Office of Zoning Administrator v - 01 z <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT . <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < �T ° <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use _ c <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. a <br /> . ..�d!e C Off. <br /> ..... ............ <br /> OW (p se print) / CONTRACTOR or SURVEYOR or AGENT a m <br /> ........` . ..r. �l.. 'r`✓./....................... <br /> -..v?��........ ;1.....1�! <br /> ADDRE ADDRESS <br /> ........... ............................................................................................ <br /> ADDRESS ADDRESS <br /> S�? � 76 ors - '� iyl � <br /> ,S"d.............. . ................................................ <br /> PHONE PHONE :� a <br /> .......... <br /> PLUMBER WELL DRILLER <br /> i <br /> ADDRESS ADDRESS <br /> : o <br /> 0 < � <br /> ......................................................................................... —' <br /> . . . ........... . . <br /> PHONE PHONE � � :\ <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms <br /> New Building No. Bedrooms ° <br /> .......... Type of Construction: •••••••••• � <br /> Addition Septic Tank Size Gals. .......... <br /> .... ...................... <br /> Sanitary .......... Size ..,cR j��. ft. x ...3.2— ft. •••••••••• ; <br /> Filling ..••.••••• Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving YP Soil Type .................................... <br /> .......... Area ........................................... r <br /> Grading .......... Slope .......................................... ; ° <br /> Mobile Home Perc. Rate ................................... <br /> 3. Use (describe exactly, 1 family 'W <br /> Privy ...••••••• home,garage,motel, etc.) Dry Well .......... <br /> Well Seepage Trench .......... <br /> .......... <br /> Subdivision Privy .......... <br /> .......... .................................................... <br /> Seepage Bed .......... i. ; <br /> ---------------------------------------------------------------------- cn <br /> Location of proposed structures and existing structures,well,sewage systems,roads,etc.,should be sketched in Fig. A. Include road <br /> setback, side and back CL <br /> yard dimension and location and setback from all bodies of water. If property is located at a highway inter- Q- <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. <br /> ---------------------------------------------- -------------------- <br /> 5. L tSize: Fig. A. 6. Locat' Q <br /> ( OSe r& ' <br /> �• <br /> 1 .• -I <br /> CD <br /> r <br /> N <br /> o <br /> ° <br /> 01 <br /> / C 78 <br /> X to r— -V Cn oo z <br /> n Q' <. fD c CD <br /> m <br /> z oa D : c C m <br /> o —_ 70 <br /> —4 <br /> CD M <br /> .............. p <br /> Signatu of Owner or Agent / Date ° C <br /> X <br /> i <br /> Remarks ......................................................................................................................................................................... CD <br /> m <br /> ........................................................................................................................................................................................ to <br /> ............ .. ...................... <br /> yo� Efl <br /> Inspection Date : : o 0 0 0 o U1 m <br /> p � ?'L .f .. ...........�'i's <br /> ..Zoning Adtrator'�`� 0 0 0 0 0 0 Cn <br /> TOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> efore construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> his application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build- <br /> ig until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> rith 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 />