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Burnett County Office of Zoning Administrator <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT ; 3• 3 — <br /> O i� <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the $ # `•C) <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wisconsin. g <br /> RICK HA-2DE'R A.M.EARTHY'0,3KS QON T„•IB,Q••.,,.,.,.... A <br /> OWNER (please print) CONTRACTOR or SURVEYOR or"AGG <br /> ENT <br /> STAB iOUTE P.O.BOX 71 -E <br /> ............... <br /> ADDRESS ADDRESS <br /> SPoor� , t,rl 54.801 SPOONER, '11 54801 <br /> a <br /> ...................................................... <br /> ADDRESS 'A—D-0RESS ' <br /> ................................................................................ <br /> 715-635...7595.................................................. � •`. ': <br /> PHONE PHONE EI <br /> Ar1n...J.�...Helm <br /> ......................................... .................................................................... <br /> PLUMBER WELL DRILLER ) <br /> ADDRESSSP.O...O.NERL54801 ................ .............. (7L <br /> o <br /> ................: .. A. D...D.R. .E.S.S............................. ................... <br /> n 0 ' <br /> O 41 <br /> ........................................................................................... .PHO-14-0-...NE......................................... ....................................... <br /> PHONE Z <br /> DESCRIPTION 4. SanitaryFacilities: ° o ° <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details "”""" i4 <br /> NBuilding Type of Construction: No. Bedrooms ...D..... <br /> aw <br /> Septic Tank Size Gals. ij1� <br /> Addition ... .................................................... ... � < <br /> Sanitary ...,X.... Size .............. ft. x .............. ft. ....... <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area ...................... Soil Type .................................... <br /> ................... c <br /> Mobile Home .......... Slope .......................................... .. <br /> Privy .......... 3. Use idescribe exactly,'1 -family Perc. Rate ................................... <br /> Well .......... home,garage, motel, etc.) Dry Well .......... S E <br /> Seepage Trench o <br /> --Sampi gon t .......... <br /> .......... .................................................... <br /> Camping Unit Privy . ...... . <br /> Seepage Bed blit... .C,� <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. <br /> C <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is located at : Uj _ - <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersection. <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. :Q o <br /> ---------------------------------------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: 0, I <br /> ................ ft. x .............. ft. . ............................... sq.ft. ............................................................................... ? ` <br /> i <br /> SEE ATTACHED .SHEET o o/I ,e,, <br /> EW <br /> vl <br /> vl <br /> f <br /> Z <br /> 0 <br /> d <br /> �m <br /> T— <br /> nv Doo W -0 <br /> ° « Qm <br /> m n n y <br /> m O <br /> O wo D 1 <br /> "no <br /> mn ' <br /> 20 m <br /> o <br /> .......... ...........P-.a-..3.-..d .... o <br /> � C <br /> ... .. .. .... . . A <br /> Si lure Ow r or Agent Date o <br /> Remarks .y:�=..................................................................................................................... — <br /> 8 : 8 <br /> Inspection Date /A . .... . .�......... �... ...%......2.....+. . .7.h 1.�� . . ............... U1NN O O � m <br /> a Vq <br /> Zoning Administr. or 5Yy) 8 8 8 8 8 8 0) <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities 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 />