Laserfiche WebLink
Burnett County Office of Zoning Administrator �' c <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. �j <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and '� O <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws nd 3 <br /> regulations of the State of Wisconsin. <br /> c ..a(. J... lJ.(.L�1�.h .. A)le.s.............. ...................................................................................... ..... �^ n <br /> OWNER (please print) CO <br /> L' CONTRACTOR or SURVEYOR or, AGENT <br /> ACDDRE ADDRESS n1..(]s ..,I........................ <br /> ADDRESS ADDRESS <br /> ......ifil................................................................................. ..................................................................................... ...... <br /> PHONE PHONE � Q <br /> ........................... ... <br /> . ............................................................ . . ... .....LL...E..R... ........................................................... ...... <br /> PLUMBER WEL.. .. L..D..RI <br /> A...D..D...R..E..S..S........ ............ .......... ..... .......................................................... ...... O ylam <br /> .............. ................. ...... ..... .A.D. .D.R..E.S.S. . . . . . <br /> n p <br /> ........................................................................................... <br /> PHONE ^_. < <br /> ................................................... ................................ ...... O » <br /> PHONE „], u <br /> DESCRIPTION 4. Sanitary <br /> Facilities: ° o 0 <br /> 1. Work: 2. New Building Details No. Bathrooms a `�- <br /> New Building Type of Construction: No. Bedrooms ... <br /> .. ... v <br /> Addition .......... .................................................... Septic Tank Size Gals. ... ...... i <br /> SaniterY .......... Size .............. ft. x .............. ft. ... ...... i <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving Soil Type ............................. ...... <br /> .......... ........................................... <br /> Mobile Homer i <br /> Slope <br /> ............................ <br /> o <br /> . . . v <br /> Privy .......... 3. Use describe exactly, -family Perc. Rate .......................... . ..... <br /> t i <br /> Well <br /> .......... home,garage, motel,etc.) Dry Well m <br /> Subdivision Seepage Trench z <br /> ................................................. .. o <br /> Camping Unit Privy ... ...... <br /> .................................................... Seepage Bed <br /> ... -- <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketchedin Fig A. <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is local of at ` <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersects n. <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. TTl''y, — <br /> Y� O <br /> 5. Lot Size: Fig. A. 6. Location: i <br /> M . <br /> ................ ft. x .............. ft. — sq.ft. QC <br /> M�" ! 0 <br /> Amp Mr I I � l N O <br /> o ] <br /> ] T <br /> II -- O V <br /> M <br /> M( M!�m rJ��, 0 <br /> J � ] <br /> T :V" <br /> Z <br /> O <br /> d <br /> b <br /> m <br /> m c m m <br /> S. m <br /> nfwQ < ] ] n —. m—. m <br /> a o< d o 3 3 3 <br /> m m o <br /> 9 ] . o <br /> o c m <br /> }� 0 : O <br /> n <br /> ........................................................................... .......... ........................... : m <br /> Signature of Own r or Agent y 1 (� Date <br /> r �^� ! o <br /> Remarks ...Nf�v as C( ...�Pr.1.lY1,L4�. .-..LI�.Iq......L.R,..`1. .25... ....I ............................................ ... <br /> u <br /> .......................................................................................................... ... ....................... ... .... .... ...............�.. <br /> ... o <br /> Inspection Date ....................................... ..... . . .. .!..:....../..AdmIL,G * Ch 1' ...... e cn N m o N �I <br /> m <br /> Zoning inistrat r /'7? o o o m <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary fac lities before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this appli ation before a permit will <br /> be issued. Do not purchase or install a septic tank,do any plumbing or start any building until a permit has been issued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans ors DeclfIca tions shall not be <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APP OVED. <br />