Laserfiche WebLink
Burnett County Office of Zoning Administrator o z <br /> 0 o <br /> APPLICATION FOR SANITARY — LAND USE = BUILDING PERMIT 3 <br /> Z <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 c �� <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. o- <br /> Tl� �/ . ` /k/QGF/� G/=d /�a <br /> ..... ...................... ............................................................... 3 <br /> OWNER (please print) CONTRACTOR or SURVf,YOR or AGENT a <br /> ......................................... ... <br /> ADDRESS ......................................................................... �1� <br /> � �J ADDRESS Z <br /> �6.f..YJ,.. :. ?� .,... ..... .............. ' <br /> ADDRESS . . ...... . ............................................................................... :'V <br /> ADDRESS tt� <br /> ........................................................................................... <br /> PHONE . .......................................................................................... <br /> PHONE DQ <br /> ........................................................................................... <br /> PLUMBER .WE.....L.L D.......RI.. ...................................... %...................................LLE.. R �i <br /> ........................................................................................... .AD..DRESS... . . . ............................................................................... <br /> ADDRESS <br /> m G <br /> 0 c <br /> O <br /> PHONEPHONE................................................................................ � <br /> DESCRIPTION 4. Sanitary Facilities: ° o 0 <br /> 1. Work: 2. New Building Details No. Bathrooms .......... EF !f0 <br /> New Building Type of Construction: No. Bedrooms .......... z <br /> addition ..... . .. ,t!11{ Septic Tank Size Gals. .......... <br /> Sanitary .......... Size ...P . ft. x ...3.. .. ft. .......... .� <br /> Filling/Grading .......... Height...y...... Stories ............... 4a. Absorption Field Site: <br /> Moving Area ........ Soil Type .................................... <br /> Mobile Home Slope ......................... .......................... <br /> O <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Well ,..,.,,,,, home,garage, motel, etc.) Dry Well .......... <br /> Subdivision G� ` �/= Seepage Trench <br /> .......... .......... <br /> ....... . ........�................. <br /> Camping Unit .......... ... ... Privy :. <br /> ........................................ .......... <br /> Seepage Bed .......... <br /> -------------------------- ---------------------- +-t— N Z <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- a <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING -1 5 <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. '" <br /> o \ <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... sq.ft. ............................................................................... <br /> fD <br /> N o' <br /> N <br /> n � s <br /> T <br /> Z <br /> s <br /> I <br /> M C w a W <br /> V fZ <br /> 1 <br /> r �. N�: c: d ¢ OJ <br /> v Z <br /> IN o o0N', m $ E. m <br /> O <br /> Q <br /> f � � p <br /> v � <br /> ...... ..... .............................................. <br /> 0 <br /> Signature o�er or Agent Date <br /> Remarks : ' ' m <br /> .............. m <br /> ...................................................... <br /> ................................................................................................................................. <br /> . . . . . <br /> /1 ...... �II <br /> ......................................................................................................... . .. ................. // <br /> ................... <br /> Inspection Date ....................................... a : . <br /> ZoninAdm. inist... ...X.... <br /> u <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 most 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 Zoning Adm 'mistratol. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />