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ett County Office of Zoning Administraor <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT g 3• o <br /> U THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described nd :(Jr, <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of he <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws nd 3 <br /> regulations of the State of Wisconsin. Jn' — <br /> David N. Volkmann P fr . A ✓ °� <br /> [) 11 t^Gc .......... .��.(..�.:.. .......... ...... ... `" .o <br /> OWNER (please print) CONTRACTOR or SURVEYOR or A ENT ; <br /> 3009 Harding At. N.E. Op, <br /> ......................... ....... <br /> � ...t.a. (o <br /> ADDRESS <br /> ADR.ES. .............. <br /> MinnepolisN] 55412 C•IiCP P?i� Sz� <br /> ss-�_)I.q............................................................... ........ ......... . ... .................................. . ,.: —aN <br /> '• ::E•(aN'D <br /> ADDRESS S <br /> • <br /> oo <br /> ADDRESS •� ;w <br /> 612-786-7341 <br /> ..... ..... <br /> PHONE PHONE <br /> Donald Daniels <br /> ......... . . .. i <br /> PLUMBER WELL DRILLER ................. ....... ..................... <br /> ••••Siren.<-.WI..._.54872 o :0 <br /> .................................................... .AD......DR... ..ES.......................................................................... ..... <br /> ADDRESS S n o :O <br /> 7]5•-349.. ... =' tw <br /> PHONE PHONE Z H :n <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> 1. Work: No. Bathrooms '� 3 <br /> X. 2. New Building Details •��� ���•• � c <br /> New Building •�1 Type of Construction: No. Bedrooms ... <br /> Addition . . ....... .................................... Septic Tank Size Gals. .... ..... <br /> Sanitary Size'./.!�cs..k,ft. x ...........r ft. Holding tank <br /> Pltlingf Gredinp .......... Height............. 300L1 .gal pq <br /> •.�..•. / <br /> Stories4a. Absorption Field Site: <br /> ............... <br /> Moving .......... Area lzld.d.... Soil <br /> Type .................. <br /> ..................... o <br /> Mobile Home . Slope .......................... <br /> .......... m <br /> 0 <br /> . m o <br /> Privy ,,........ 3. Use (describe exactly Perc. Rate ............................ <br /> ,�1 -family .•�•� � <br /> y <br /> WWellhome,gara e,mo Dry Well <br /> I, etc.) <br /> subdrotabn ,� /.A q ..w... Q. :�c........... Seepage Trench ... o `� <br /> Y'! .. ... <br /> ♦ Priv ... ...... <br /> CampingUnit .......... ... ....0. ..'......4.1'G.I21.Y.............. y j <br /> Seepage Bed . . .... to <br /> ------------------------------------------------------------------- -- o <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig A. <* =:r• <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is local d at 5 •� <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersecti n. � o <br /> «� <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. T! `:� o <br /> ------------------------------------------------------------------- -- <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ........................................................................ <br /> 2P <br /> S <br /> _ <br /> :W <br /> 0 <br /> 0 <br /> I <br /> T :W <br /> J / _ :Z <br /> z <br /> Z <br /> 0 <br /> IV 71 <br /> 7V O1 <br /> it m <br /> N <br /> E <br /> m c m m 0 m m -C <br /> or^o < = = 0 -� - m <br /> adc055ic <br /> p n m <br /> Z o D ' 1 <br /> oN0 Na <br /> o n M <br /> m <br /> o = 0 0 <br /> ...... ................. . ........ ............................. <br /> m <br /> a ' O <br /> Signature of Owner or Agent Date o <br /> o , <br /> Remarks m y <br /> A <br /> o . <br /> ......................................................................................................... .... .................. .. .................. l <br /> 0 <br /> o ; <br /> ........................... ... <br /> «+ mInspection Date N N N <br /> ....................................... .............. . . P .P0o <nm <br /> Zoning A ministrator <br /> NOTE: A preliminary site inspection must be made and site pproval granted on all structures involving sanitary fac lilies 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 />