Laserfiche WebLink
rnett County Office of Zoning Administrator o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. <br /> o y J <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as 7 <br /> .�J <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use CD e <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 o. <br /> a X 0 <br /> �...... ...a..:. . .. ............. -u................., .........................i <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a CCD <br /> 1�'. .:...... ....................................................................... T.... ............ o .......a? 6....................................... <br /> AD/D�RESS ADDRESS LCD <br /> .manta d .. v <br /> ADDRESS .......................................................... ADDRESS.............. ,5........................................................ <br /> PHONE PHONE <br /> s....... ..... . ........................ <br /> PLUMBER <br /> .t .. .>>i.l?'"......... !.[.��.SC.:.................................... ............................................................................................ i <br /> ADDRESS A05fiESS- <br /> m G) <br /> ........F.� ............. �.�.............................................. 0 <br /> z <br /> PHONE Pki,&NE <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details ` o <br /> New Building .......... Type of Construction: No. Bedrooms ......... <br /> ddition Septic Tank Size Gals. .......... <br /> ......... .............................................. <br /> Sanitary .......... Size .4.�j! ... ft. x ....>Sa�.... ft. <br /> ......... <br /> Filling Height..` ..... Stories ..... ........ <br /> 4a. Absorption Field Site: <br /> Soil Type .................................... r- <br /> Moving Area ....� 5!c� ..aQ2.,.. ..�..... o <br /> GradingSlope .......................................... <br /> Mobile Home .......... 3. Use (describe exactly, 1 family Perc. Rate ................................... E <br /> Privy .......... home, arage, motel, `.) Dry Well .......... <br /> Well Seepage Trench .......... '• <br /> Subdivision �rti aFk Privy i <br /> Seepage Bed .......... i <br /> —————————————————————————————————————————————————————————————————————— N \ <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched in Fig. A. Include road e <br /> Q <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- Q; <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. p' <br /> :3---------------------------------------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: `' <br /> ................ ft. x .............. ft. — ............................... sq.ft. ............................................................................... <br /> C <br /> 0 <br /> N O <br /> o D <br /> o � <br /> 0 <br /> X3 : _S <br /> N <br /> CD <br /> CD <br /> C Na- �v� cnWZ <br /> CD c d <br /> — - <br /> N, <br /> 6z;; m <br /> Z o o `D <br /> o c <br /> o <br /> N CD CD M <br /> .......... ........... ��`t.............................. ...0 ...��:....!�`........ o p... . ........ .... ..... <br /> Signature of Owner or Agent Date — <br /> _® / X <br /> Remarks `? Gs^ .... A �l / ?n>. ,ccr.................................................... CD 0 <br /> CD 0 <br /> !/ CD <br /> En _ <br /> . . . . <br /> ........................................................................................................................................................................................ o00o cNs, m <br /> ,D C: <br /> Inspection Date ....................................... C�J?tc?...1...-...... ........ ...... ....... <br /> 0 0000 ' om <br /> Zoning Admini trator KJ o 0 0 C o t/) <br /> VOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> jefore 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 Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />