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Burnett County Office of Zoning Administrator u 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <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 m :� <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 <br /> .•..... rr Construction Co. Same O <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT O. , <br /> ^;a�rrte He <br /> 189.5...East...Qt.1'.r....Ra <br /> .......F• <br /> ADDRESS ADDRESS » i <br /> White.•Bear .Lake ...Minnesota 55110 <br /> Lake, ............................................................................................ <br /> ADDRESS ADDRESS............................................................................. <br /> 6 iz-77�-.5675........ . <br /> PHONE PHONE p '� <br /> Ra-Mar PlumbinE..Inc........................... \ <br /> PLUMBER WELL DRILLER <br /> ... Ave. <br /> 81 Lake Elmo AChell Well Drillin. ................................ <br /> 5.5 <br /> ................................................................... . . . . . . . ......................... ........... . ..... o <br /> ADDRESS ADDRESS <br /> Stllwater Minn. 55082 <br /> .t.................... . ....................... ........... . . o a <br /> ...................................... .......................... .... . ... .. ..............................,......... <br /> PHONE _ qq_((� r� PHONE Z H r <br /> 61 <br /> DISC T-19N6 r 4. Sanitary Facilities: ° ° ' <br /> 1. Work: 2. New Building Details No. Bathrooms .......... o <br /> New Building ., Type of Construction: No. Bedrooms .......... <br /> Addition .. ..... .................................................. Septic Tank Size Gals. .......... <br /> Sanitary .......... Size .............. ft. x .............. ft. .......... i <br /> FillinglGrading •.....,... Height............. Stories ............... 4a. Absorption Field Site: i <br /> Soil Type <br /> Moving .......... Area ........................................... t o <br /> Mobile Home ... . <br /> Slope .......................................... I » <br /> Privy .,,....... 3. Use (describe exactly, 1 -family Pere. Rate ................................... .C_ E E <br /> Well •......... home,garage, motel, etc.) Dry Well <br /> Subdivision Seepage Trench .........I r- i �jf <br /> .......... .................................................... <br /> Camping Unit .......... Privy .......... <br /> .................................................... Seepage Bed .......... <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 <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. i,) i o <br /> --------------------- -------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. . ............................... sq.ft. ............................................................................... <br /> co <br /> Water System and Sanitary System to be part of new motel complex, , <br /> on Lots 1, 2, 3, Plat Of J.O. & W.R Barges Riverside Lots in Gov. 0o <br /> Lot 3, Sec. 25, T40N R17J, Town of union } <br /> o U� <br /> J <br /> Z <br /> ° <br /> a <br /> �J N r V 0 M Z <br /> IE <br /> C N c m <br /> � . _. m <br /> Z oo Dn <br /> .....! . . ...... .... . .......... ... / - 4 .. ....8'S... <br /> . ... .. �. ... // <br /> Signa re of O net or en // -4/D <br /> Signa » <br /> 7 i 7 x <br /> Rerks,.S.. .......1/ .. -.a.a.. ............................................................................................................ : o <br /> ............................................................................................................. <br /> ea <br /> ............................................................................................................ ... .........../.. ... ....... . ...................................... \ T <br /> Inspection Date ....................................... ..... . ..:: 1..::..... y. ............ o ren o m <br /> A: <br /> Zoning AdminOrator ` 8 8 S S S 8 y <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary fecill es <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 not purchase or install a septic tank, do any plumbing or start any mild <br /> - <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 />