Laserfiche WebLink
commeroo.tad.gov Safety and Buildings Division County <br /> 201 W.Washington Ave.,P.O.Box 7162 Burnett <br /> ' Onsin <br /> Madison,WI 53707-7162 Sanitary Permit Number(to be Shed in by Co.) <br /> of Consmerce 65/z01 <br /> Sanitary Permit Application Sta<`eT ansactimr Number <br /> In accordance with s.Comm.83.21(2),Wis.Adm.Code,submission of this form to the appropriate governmental (i�r/rl(�1 �e-(/iCW <br /> unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are Project Address(if different than mailing address) <br /> submitted to the Department of Commerce. Personal information you provide may be used for secondary v , <br /> in accordance with the Privacy Law,s. I5. 1 m,Stats. FN#21965 Spirit Lake Access Rd. <br /> 1. Application Information-Please Print All Information <br /> Property Owner's Name Parcel# <br /> Peggy and John Lenke Lob 07-0342-37-18-12-5 05-001-026000 <br /> Property Owner's Mailing Address Property Location <br /> 1477 Arden View Drive <br /> City,State Zi Code Phone Number Govt.Lot 1 '/.,'/., Section 12 <br /> P (circle one) <br /> Arden Hills MN 55112 T 37 N; R 113 E m W <br /> H.Type of Building(check all that apply) Lot# <br /> 1 m 2 Family Dwelling-Number of Bedrooms'3 D 672 2 Subdivision Name <br /> Block# <br /> ❑Public/Commercial-Describe Use <br /> ❑City of <br /> ❑State Owned-Describe Use CSM Number ❑village of <br /> III Town of Trade Lake <br /> IH.Type of Permit: (Check only one box on line A. Complete line B if applicable) — <br /> A' ❑New System 0 Replacement System ❑Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System(explain) <br /> B. ❑ Permit Renewal ❑Permit Revision ❑Change of Plumber ❑Permit Transfer to New List Previous Permit Numbe and Date Issued -7 <br /> Before Expiration Owner a 659 ��/v7 2 (a-<(_8 p� <br /> IV.Type of POWTS System/Component/Device: Check all that apply) <br /> J <br /> ❑Non-Pressurized In-Ground ❑Pressurized In-Ground ❑At-Grade ❑Mound>24 in.of suitable soil ❑Mound<24 in.of suitable soil <br /> r Holding Tank ❑Other Dispersal Component(explain) ❑Pretreatment Device(explain) <br /> V.DispersaVIrreatment Area Information: <br /> Design Flow(gpd) Design Soil Application Ra* pdsf) Drspersat Area Required(sf) Dispersal Area Proposed(sf) System Elevation <br /> 450 Na Na Na) Na <br /> VI.Tank Info Capacity in Total #of Manufacturer <br /> Gallons Gallons Units o u S <br /> New Tanks Existing Tanks U <br /> p o <br /> 6 U lir vsi w C7 0. <br /> Septic or Holding Tank 2000 2000 1 Wieser Concrete WLP X <br /> Dosing Chamber <br /> VIL Responsibility Statement- 1,the undersigned,assume respond ' for installation of the POWTS shown on the attached plans. <br /> Plumber's Name(Print) PI Si MPIMPRS Number Business Phone Number <br /> Robert Carlson <br /> MPRS#135655 715fi53-25110 <br /> Plumber's Address(Street,City,State,Zip Code) <br /> 3572115th St. Frederic WI 54837 <br /> VIII.Counyj$tepartment Use Only <br /> Approved ❑Disapproved Permit Fee Date Issued Issuing iTature <br /> ❑Owner Given Reason for Denial $37/�j� IMQOfzwf <br /> IX.Conditions of Approval/Reasons for Disapproval S- <br /> Abl-6: 5weMisr {}plGun JanK i5 ,(fit <br /> 17o�C Alar' of: 30T 1-,V6 oo fhe rRM Ff &Voc t G;�HbY <br /> 0,4a Act, j9. X08. OCT 18 2011 <br /> Attach to complete plan for the system and submit W the County a*oa ppor wt km Wan 11 h. is dee <br /> BURNETT COUNTY <br /> ZONING <br />