2008/07/25 - LAND USE - SUB - Subdivision

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Burnett County Office of Zoning Administrator 0 0 APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 o �) TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and looted as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Lad Use m ince, San itat eon Code, with all other applicable County Ordinanceand laws and reg t�s of the State of Wls onsln. n ; J� MV j I�jPCr cam.... (�St�r. — r..... u. ... .. .. ...... ........ ........................... ... OWNER (plea;i print) CONTRACTOR or Sw RVEYOR or AGENT . ....� .....�.. ... ADDRESS AD DR SS ADDRESS ADDRESS PHONE PHONE ........................................................................................... WE. . .L..... DR...I..LLER.L'E' ...................._._.................................L......... , PLUMBER L p i ..............L.... ... ........................................................................................... . ................................................................ .. _. .� ADDRESS AD.. DRESS n o .......................... ........................................................................................... . ...................................... ..........ti2 l.......... o .: PHONE PHONE...... H r , DESCRIPTION 4. Sanitary Facilities: ° o ° 1. Work: 2. New Building Details No. Bathrooms .......... o New Building No. Bedrooms .......... Type of Construction: E Addition .......... .................................................... Se Ptic Tanto k Size Gals. .........""""" Sanitary .......... Size .............. ft. x .............. ft. .......... Filling(Grading .......... Height............. Stories ............... 4a. Absorption Field Site: Moving ...I...... Area ........................................... Soil Type ......................... .......... o Mobile Home Slope ............................... .......... .......... Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ........................ .......... Well .......... home,garage, motel, etc.) Dry Well .......... Subdivision ..... Seepage Trench .......... ..... .................................................... Camping Unit Privy I......... .......... .................................................... Seepage Bed .......... ---------------------------------------------------------------------- Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig_ A. Inclu e road setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highw y Inter- �_- section, show the Intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EX STING a STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o ----------------------------------------------------------------------- 5. Lot Size: Fig. A. 6. Location: ................ ft. x .............. ft. . ............................... sq.ft. ................................................................... ........... ^ I N o (/ 1 O i o 0 `r T lJ o rf — m Z o < m 2 m R > n L, i 1'u1 n 3 n Signature of Owner or Agent Date X 7 Remarks ......................................................................................................................................................................... n ........................................................................................................................'...................................... .......... ....... . . . . . . w Inspection Date ...... ....... ...... .... .... .... .. �........ % Zomng Administrdtor NOTE: A preliminary site Inspection must be made and site approval granted on all structures Involving sanitary facilities before construction can begin. In the case of sewerage disposal systems, a copy of the percolaten test must be attached to this application before a permit will be issued. Do not purchase or Install a septic tank, do any plumbing or start any build- ing until a permit has been Issued. A permit may be revoked if misrepresentation of any of the information conveyed here- with is found to exist. Changes in plans or specifications shall not be made without approval oflthe Zoning Administrator. SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICEII AND APPROVED.