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Burnett County Office of Zoning Administrator n --Iz <br /> ,APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> 0 ° <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 Lan J Use ' <br /> Ordinance, Sagitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 0. <br /> William F. Coulson H d Ql o <br /> ................................................. . .................................................................................. ....... m^ <br /> f <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT <br /> ......1. .26 Knollwood Drive a <br /> . .......... . ............................................................... .ADDRESS.................................................................... ....... 1 <br /> ADDRESS d <br /> River..Falls WL.,•54022 t5lJ L <br /> ADDRESS ADDRESS i— <br /> i <br /> I — <br /> .:425 <br /> F— i <br /> 7.15-425•-5505 <br /> ........................................ .......PHONEPHONE .O <br /> _..... ....... <br /> PLUMBER WELL DRILLER <br /> O <br /> ADDRESS ADDRESS M <br /> o <br /> P........... .•.•.................................................................... .PHON..E........................................................................ ....... o < _ <br /> HONE•. ...... z .» <br /> DESCRIPTION r <br /> 4. Sanitary Facilities: �. <br /> ° o <br /> 1. Work: NoBth -� <br /> 2. New Building Details No. <br /> w Building .. TyaofstrUGtion: No. Bedrooms .. ....... <br /> Addition Ck IWOOCIJ <br /> ....i{7w. ............................................ ...... y Septic Tank Size Gals. .. ....... < <br /> Sanitary .......... Size .....1Q.... ft. x , ft.# •• •••.•.. '• <br /> Filling/Grading „ ,,,,,,.. Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area ............................I.............. Soil Type ............................ ....... <br /> Mobile Home Slope .................................. ................. <br /> _ .. <br /> Privy .......... 3. Use (describe exactly, I -family Perc. Rate ........................... ....... _ <br /> Well .......... home,garage, motel, etc.) Dry Well ,. ..,•,,, � <br /> Subdivision .......... Seepage Trench .. ....... iL'1 <br /> .......................................I............ <br /> Camping Unit Y <br /> ......•.., Priv .. ....... <br /> Seepage Bed <br /> -------------------------------------------------- --------- -- <br /> Location of g B y 0 m <br /> 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 niter :� a <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXiS1 ING5 <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. —IN <br /> ----------------------------------------------------------------- <br /> -- o <br /> 5. Lot Size: Fig. A. 6. Location: I � � Z <br /> ..IGO....... ft. x ...250.... ft. - ..250.00.................. sq.ft. I . .. ... . <br /> —t <br /> Govt. Lot 4, Section 29-T4ON-R16W and in the NW4 of NE4, Section 32-T40N-R1 W Town f im" y <br /> a f gS I Oak and, <br /> IN O. <br /> 7 <br /> _ <br /> [71� i �l <br /> o z <br /> ' C dna � �m Z <br /> ^ am <br /> z oo . n <br /> S P��fu <br /> ° <br /> IT <br /> _o 0 <br />\* <br /> May 6, 1986e <br /> J ; <br /> Signature of Owner or t Date (��j° C <br /> j //yam” ^ I x JJ <br /> Remarks ................C�? (. /.. <br /> .........................................�v / C 7 _ <br /> ... .. ..... ......../.... ...........//.;...... .................. .. m <br /> ...I..� o <br /> SII <br /> Inspection Date ............................ i• N ry — m N m <br /> .q?.- <br /> � .. . . .......... .................................. . Nvo � ovm <br /> Zonin A ministrator ' <br /> 9 � � goo $ oof/) <br /> NOTE: A preliminary site inspection must be mad nd site approval granted on all structures inv Iving sanitary facilities <br /> before construction can begin. In the case of sewerage disposal systems, a Copy of the percolation t st must be attached to <br /> this application before a permit will be issued. Do not purchase Or in Stall a septic tank, do any plum aing or start any Iruild� <br /> ing until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveye.. 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 />