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Burnett County Office of Zoning Administrator o 0 <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 < N µ :rte <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> Kenneth Knauber - <br /> O <br /> n F <br /> OWNER (please print) CONTRACTOR or SURVEYOR or, AGENT a <br /> �a <br /> . . ...... ............................................................................... c <br /> .....Rt�....1.....B.ax..257..................................................... ... :r <br /> ADDRESS ADDRESS :P <br /> ......F.reder.ic.....WS....546.7.3......................................... [b� :m vs <br /> m <br /> ADDRESS ADDRESS <br /> Z.1.5-32Z-B.962......................................................... :°� E m <br /> PHONE PHONE k✓ <br /> .....dlottald..Daniels..................................................... ............................................................................................ ' <br /> PLUMBER WELL DRILLER [� <br /> ......Box..W..............Siran. ...WI.....548'72....................... o <br /> ADDRESS f ADDRESS n o ' <br /> 715-463-2333 n < <br /> ........................................................................................... ............................................................................................ o <br /> PHONE PHONE Z „D, r <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: 2. New BuildingDetails No. Bathrooms ......... v <br /> i o <br /> New Building No. Bedrooms 3..... _ <br /> Type of Construction: i:: <br /> �w <br /> Addition .......... <br /> , ....... ... .... ,,,,,, Septic Tank Size Gals. .......... a ^ <br /> ............... ................ v�[} <br /> Sanitary .....X.. Size .............. ft. x .............. ft. .......... t� <br /> Fillingi(Grading .........• Height............. Stories ............... 4a. Absorption Field Site: ^� <br /> Moving .......... Area ....................... Soil Type ................................... <br /> .................... <br /> Mobile Home Slope ................................ . _., <br /> i o i <br /> :µ .. <br /> ba <br /> Privy ,,,,,,,,,, 3. Use (describe exactly, 1 -family Parc. Rate ................................... O :3• ' <br /> Well .......... home,garage, motel, etc.) Dry Well .......... LL r t <br /> Subdivision Seepage Trench .......... <br /> :w :w <br /> Privy . <br /> Camping Unit .......... . .. ................ ..... \ :a= <br /> �� � Seepage Bed —N :o' <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched In Fig. A. Include road V1 'o .0 o <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 ii-d a <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING Q� io 5. a <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. :T. o <br /> 0 z <br /> 5. Lot Size: Fig. A. 6. Location: Q � <br /> ................ ft. x .............. ft. — ............................... sq. ft. ............................................................................... <br /> c: <br /> K <br /> r <br /> Co <br /> i� <br /> N O <br /> o :() � <br /> 7 <br /> 0 <br /> 0 <br /> T <br /> - W <br /> Z <br /> O <br /> r <br /> i.0 00 <br /> ]J Vl r H <br /> 0Z <br /> c m m c m <br /> m <br /> an < . m <br /> O y n <br /> 0 0 ? a57J <br /> rn <br /> � ...... . � � 1........1.......... s <br /> ' 4. . ...... .................................... - 3 Y.B....... o <br /> Signature of Owner or Agent Date . . . <br /> /� ,/ _/ <br /> Remarks �F—' /( L6 L.d7�--r `'— ......................................................................................................... tt x v <br /> ... ..... .. ...'.............................................. : <br /> ...........................I...............`........................................................................................................................................ <br /> ter ' <br /> ZD <br /> .......................................................................................... ... .................................. ........... ............................. t . . . . <br /> /� �J H <br /> Inspection Date ..1./...../: ..- ........ .,..CL„-pc.9....L..:..... !L?r.... u' u o u, o v, <br /> 4s.-�......................... d: ra n� m ro m <br /> Zoning Administrator �U 8 8 8 8 8 8 ti <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 riot 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 tfe made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br /> 033 <br />