Laserfiche WebLink
Burnett County Office of Zoning Administrator o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as �G <br /> O <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use I c pW <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 ma <br /> o <br /> ...... ........ ................................... ............................................................................................ <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT <br /> ADDRESS............. ....... ............. ..........................r ...i......... .............. <br /> 01 ..... Csr.................................. ............................................................................................ d� <br /> ;Z <br /> �1 <br /> ADDRESS ADDRESS <br /> ........................................................................................... . .......................................................................................... <br /> PHONE <br /> PHON.E. ............................................................................... <br /> ............................................................................................ <br /> PLUMBER WELL DRILLER <br /> O <br /> ....... . ................................................................................ . ................................................................................ m <br /> ADDRESS ADDRESS A <br /> PHONE PHONE `tl <br /> DESCRIPTION r <br /> 4. Sanitary Facilities: ° o ° <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details •• • ••• o <br /> New Building ,,.,...,,, Type of Construction: No. Bedrooms .......... <br /> Addition .................................................... Septic Tank Size Gals. .......... < i <br /> .......... <br /> Sanitary ....•.•... <br /> .......... Size .............. ft. x .............. ft. <br /> Filling/Grading ,,,,,,,,,, Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving Soil Type .................................... <br /> .......... ........................................... <br /> o <br /> Mobile Home .......... Slope .......................................... \r p <br /> Privy Perc. Rate ................................... <br /> .......... 3. Use (describe exactly, 1 -family • \ a <br /> wen ... .. home,garage, motel, etc.) Dry Well ;\ p4 <br /> Subdivision .......... Seepage Trench .......... <br /> ......................................... .......... — <br /> Camping Unit .......... Privy .......... <br /> .................................................. _ <br /> Seepage Bed <br /> ------------------------------------—--------------------------------.......... (!C% M <br /> N <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 I <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 va � <br /> 0 <br /> ------------------------ --------------- ---------------------------- <br /> — <br /> C <br /> 5. Lot Size: Fig.C> .0... ft. x .. .Bt'?. ..... ft. — .. Q. p.......... sq..fA. 6. l c/Location: ..Fisfl...R/(E <br /> — — ---- — FCSH CAkE acdo <br /> -- ,q <br /> N J <br /> yi P(toPasr� <br /> WELL �715 <br /> f�OyE �` <br /> ca <br /> €Z <br /> a <br /> J\ <br /> _Ao <br /> m <br /> 9�W J6 X 4(U qP ro Ch a o o <br /> /.J t O .VNi w co m <br /> .. .... . .. ..............:... ... <br /> ... ._L....... a...�. . .� - <br /> r o <br /> g ature of Owner or Agent Date y : — <br /> X <br /> marksi f2.G7 ..�"..//D/.Z.................................................................................................................... „ m <br /> En <br /> ter <br /> _ <br /> II <br /> ... .. ... .. .... <br /> � : <br /> Nm <br /> Inspection Date ....................................... .. ?'21Ra.. ....:...... ........ . . ... .... u, u, o u, o ra <br /> Zoning Adminis rotor R y o $ $ $ $ $ co <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 plumbing or start any build- <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 Zomnr� Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />