Laserfiche WebLink
Burnett County Office of Zoning Administrator vis o 0 <br /> '- <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT -� 3 <br /> o <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 ;� <br /> Ordinance, Sanitation Code, and wi h all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a V <br /> ............... ................. ........ .... ... .... . .... ............................ rP o <br /> Y ^ <br /> OWNER (please pr nt y-7 //'' CONTRACTOR or SURVEYOR or AGENT a i»� as <br /> 14.T.....[.... 2`...................................... ......... ............................................................................................ <br /> ADDRESS ADDRESS » <br /> i <br /> ADDRESS ADDRESS <br /> ........................................................................................... . ................................................................................ <br /> PHONE . <br /> PHONE b <br /> ` \..........0 ...� .�-�..T............................... ..................................................................................... <br /> PLUMBER WELL DRILLER.................................................................... <br /> ADDRESS ADDRESS <br /> \ n o i <br /> ............... . . .................................................................... ... ..N'E.................................................................................. o <br /> PHONE PHO.. N <br /> z � r <br /> DESCRIPTION 4. Sanitary Facilities: ° o 0 <br /> 1. Work: 2. New Building Details No. Bathrooms ... ...... in o <br /> New Building .,., Type of Construction: No. Bedrooms <br /> Addition ...,, ,,,, u-6®D,,,,�A-V✓I'C Septic Tank Size Gals. 7S ? <br /> ...................... ..... .. . ...... . .. <br /> Sanitary ,,,,, Size ...�J..F..... ft. x 3 ... ft. <br /> �. v <br /> Filling/Grading .......... Height.....�.... Stories .....I........ <br /> 4a. Absorption Field Site: <br /> Moving .......... Area .....ITJ� ...... Soil Type ..................eg !...................... •r <br /> Mobile Home .......... Slope ....................... .Io......... :� 0 <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate .................... .......... Al <br /> ... <br /> Well ............. Dry Well ....... <br /> V <br /> �... ome garage, motel, etc.) i G <br /> Subdivision Seepage Trench .......... <br /> 9 9 <br /> .................................................... <br /> Camping Unit .......... ........ Privy <br /> .......................................... .......... <br /> ppr <br /> Seepage Bed 1C� f�3•... .... N6 <br /> 00 <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 yard dimension and location and setback from all bodies of water. If property Is located at a highway inter- r �- <br /> section, show the intersecting highways and the setbacks required along them and at the Intersection. CLEARLY LABEL EXISTING y <br /> ae <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. p' <br /> ---------------------------------------------------------------------- 7 <br /> 5. Lo ize: // Fig. A. 6. Location: (� <br /> .....��... ft. x ..`�...... ft. — ....�...../�.... sq. ft. ............................................................................... <br /> � a <br /> as <br /> O f �. <br /> 7 <br /> O <br /> 0 <br /> 0 <br /> s <br /> W <br /> �fx�-u- Z <br /> 0 <br /> a <br /> C d d C N <br /> N C d <br /> m <br /> Z e o n a <br /> o a ° 3 <br /> Pa - <br /> m <br /> o <br /> p <br /> 5. � <br /> ............ . ........... ...................... ...... `�b"C '.................... . <br /> C <br /> Signaturef Owner or Agent <br /> 7 <br /> Remarks ...�1.�/G.e!..��?.L,�-:;1.^..%. _............................................................................................................_ � � <br /> e�f <br /> ............................ t G... U.......... ...ll.LAtt: 4........................................................................................... d <br /> /,� . . .:........ _ E ............................ .. ................. ....................................... <br /> Inspection Date 9`."`�. r6. �m� ..... ? m <br /> f : <br /> /J o� <br /> .... .. ............. �f/.............................g ..... ....... .... 1................ In o rn <br /> //J Zonin Ad Inistrato� 88980000 <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 plumhing or start any budd- <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 />