Laserfiche WebLink
Burnett County Office of Zoning Administrator �' o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m `� <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and <br /> regulations of the State of Wisconcsi n. / /'�1y 3• a <br /> . . /f ...... ................ . . . . .... ................................................................ <br /> OWNER (pleue pr ntl CONTRACTOR or SURVEYOR or AGENT <br /> Aw om✓ 1c � ......................... <br /> DSS ........... .30 . . 1 . ................. .... ................. ................ .......................... <br /> ADDRESS <br /> ............... <br /> _. <br /> _J <br /> ADDRESS ADDRESS <br /> ........................................................................................... ............................................................................................ P <br /> PHONE _ PHONE <br /> .......... ...........-..........:8.6............I...................... :_. <br /> PLUMBER WELL DRILLER................................................................... --r. <br /> ADDRESS ADDRESS m 0 oe <br /> n O <br /> ........................................................................................... ................................................... ....................................... O r• <br /> PHONE PHONE Z „ 'r- <br /> DESCRIPTION <br /> i\!� <br /> DESCRIPTION 4. SanitaryFacilities: ° o » J <br /> 1. Work: 2. New Building Details No. Bathrooms .......... c \ <br /> No. Bedrooms .......... '. ` 1 <br /> New Building .......... Type of Construction: t '' <br /> ,-'Aedition .................................................... Septic Tank Size Gals. .......... <br /> Sanitary Size ..1.. ...... ft. x ....1.'f.... ft. .......... <br /> Filling/Grading <br /> .......... Height....7...... Stories ............... 4a. Absorption Field Site:/ <br /> Moving .......... Area ........................................... Soil Type .................................... r <br /> o <br /> Mobile Home .......... Slope ................... ...................... ^ <br /> Privy .......... 3. Use (describe exactly,'1 -family Perc. Rate ................................... N <br /> Well ......... home,garage,motel, etc.) Dry Well .......... a <br /> Seepage Trench z <br /> Subdivision . ........ . .. . .. .......... 0 <br /> ... .. ............... <br /> .......... . . ........ Privy <br /> __Camping Unit_________________ .f'.- .% ..T..YO.11..5.:�..,... .......... > i <br /> Seepage Bed <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. ^ ` ` <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is located at '.N <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersection. >Li <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> ---------------------------------------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location:................ ft. x .............. ft. — ............................... sq.ft. ............................................................................... I <br /> le a'( <br /> 0 <br /> IAO <br /> fi <br /> -P <br /> o <br /> s <br /> I m <br /> �GNE' <br /> Z <br /> �y o <br /> b <br /> QQ <br /> MCD M N r D 01 ca <br /> N c _. W 0 n c c <br /> .� n N 'c cr < o o n <br /> N _ _ m <br /> m a _ am as S <br /> / Q t Ol W y 7 J <br /> 3 <br /> S N `G N O m m <br /> 0 : O <br /> .... .. .. . ....... ............ v/s7 �x A, o <br /> Signature of Own kgent 1 a e - <br /> Remarks ...... . . ......`�.... C 1r.1...L.< (1.T1% .. .����7:: .................................................................... m n <br /> � .. <br /> ...................................................................................................... /. ....... .1................... o <br /> } <br /> Inspection Date ....................................... -i$L�YnL��... ... .`/f%Z(17_`i..:1.�'%...................... 'J. row it _ o o N m <br /> Zoning Admin strator-s'Y j S S S S S CA <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this application 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 or specifications shall not be <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />