|
Burnett County Office of Zoning Administrator o 0
<br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 0.) 3. �.
<br /> o
<br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located . <co H -.
<br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use "d
<br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. g n.
<br /> _ ao
<br /> John M. Nichols G ?
<br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT Iv_ m g;
<br /> 4501 Baker Road 0.. fiv 4
<br /> ADDRESS ADDRESS
<br /> Minnetonka? MN 55343 t 9.) p
<br /> ADDRESS ADDRESS " • vW
<br /> 612-935-4216 i c ' <� ,4,
<br /> PHONE PHONE �'Q
<br /> le i
<br /> PLUMBER WELL DRILLER
<br /> ADDRESS ADDRESS �� ( o y`�
<br /> o' ,,
<br /> •
<br /> PHONE PHONE z H r
<br /> DESCRIPTION 4. Sanitary Facilities: ° o °
<br /> 1. Work: 2. New Building Details No. Bathrooms o
<br /> New Building 1� Type ofConstruction: No. Bedrooms CD
<br /> • Addition �—. /� , jj Septic Tank Size Gals. ta—
<br /> Sanitary Size ..../..c&-y.. ft. x .....L..`.f:.. ft. _
<br /> i 4a. Absorption Field Site:
<br /> Filling Height...�. ..pp.. SStoriej. C
<br /> 42 Zt '— Soil Type > -1�..�• r Aa{
<br /> Moving Area r i�, o �,,,
<br /> Grading Slope 'I i
<br /> Mobile Home 3. Use (describe exactly, 1 fame y Perc. Rate
<br /> Privy ,.. ..,. , home �arage, motel, et , Dry Well
<br /> Well ... !.. ...., `►i,1(1 . ' ! Seepage Trench y� )1(,
<br /> Subdivision Privy ..•/ '�
<br /> GGNi�'� S� Seepage Bed t z
<br /> �T, V, in
<br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched in Fig. A. Include road 6 �y,
<br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- " r- '1"'1
<br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING �� 'y _•
<br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. �I
<br /> 5. Lot Size: Fig. A. .T
<br /> ft. x ft. — sq.ft. ti
<br /> t-s'
<br /> 3 r\ '
<br /> N
<br /> "itk a,N kt>
<br /> cn
<br /> co
<br /> o
<br /> ...... a sc, —IC F t2,.. cl
<br /> I `° - .
<br /> g
<br /> o
<br /> rj--; e__';..;),,4
<br /> .\
<br /> t
<br /> q
<br /> 7, `,-f z
<br /> pilFb:i-pc Willi / ') y
<br /> CID
<br /> 1 � it', r, / "u�=
<br /> ,\.) ,.)--- , p_3\
<br /> �f
<br /> c C C • . ry N
<br /> "- i '' 0 taQ = < 1D -• R
<br /> c
<br /> Z o3 ,D <
<br /> 0 _ 3 -
<br /> V *I$N. N 7c
<br /> �I o n
<br /> It-re.--
<br /> Date � �
<br /> Ilikre of Owner or Ag nt q//�/- y// 54
<br /> m II
<br /> co
<br /> Remarks .... J . -1 V 1,9 6 .6.t4 .ge i.�.� . - v�
<br /> C
<br /> Tr
<br /> rf
<br /> _* / I ikacki
<br /> 1 I J �^ n
<br /> C II
<br /> Arr- 1 LAA0,-- &14P ly '2—4 il 4 ,/ imiet-i--- "7-7 4,42 , c''' (f) -7
<br /> on
<br /> Inspection Date o ' coon
<br /> Zoning Administra o 0 o g U
<br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary fac. ias
<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 build-
<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 he made without approval of the Zoning Administrator.
<br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED.
<br />
|