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CA 1CYr1D <br /> Burnett County. Office of Zoning Administrator CD o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT g. 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as H -h <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use co V <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. B a <br /> John Haugen y d <br /> w - 7 <br /> OWNER leas print) CONTRACTOR or SURVEYOR or AGENT ro co <br /> a <br /> Route <br /> ADDRE ADDRESS <br /> Webster , WI 54893 <br /> ADDRESS ADDRESS <br /> PHONE PHONE YV <br /> Nels Koerper <br /> PLUMBER WELL DRILLER ) , <br /> Webster, WI o <br /> ADDRESS ADDRESS 0 (-- <br /> $66-8608 <br /> 5 ,*- <br /> PHONE PHONE z z • <br /> DESCRIPTION 4. Sanitary Facilities: •o o o <br /> 1. Work: 2. New Building Details No. Bathrooms ....1.... fN. o <br /> New Building Type of Construction: No. Bedrooms s <br /> Addition Septic Tank Size Gals. 750 Ca, ,3 <br /> Sanitary X Size ft. x ft. `...,t1 <br /> Filling Height Stories 4a. Absorption Field Site: <br /> Movin Area Soil Type 3a'"T) <br /> g SlopeX 1p <br /> rading <br /> Mobile Home 3. Use (describe exactly,ler Perc. Rate ..3.-.373 <br /> Privy home,garage,motel, etc.) Dry Well . <br /> Well Seepage Trench <br /> Subdivision Privy 9-) <br /> Seepage Bed <br /> I <br /> Location of proposed structures and existing structures, well, sewage systems,roads,etc.,should be sketched in Fig. A. Include road 9 ) a Z <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- j_i <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING r- . <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. i <br /> o <br /> 5. Lot Size: Fig. A. 6. Location: - . fI. <br /> ft. x ft. — sq.ft. _ ,` <br /> (J ,.J m <br /> n <br /> .: . <br /> N O <br /> 0 .., 0 <br /> o <br /> 0 LrI `C <br /> H <br /> N <br /> _ <br /> po1^ <br /> N <br /> T <br /> co <br /> o <br /> co <br /> m <br /> Co <br /> Co <br /> U\ <br /> [CD (217 .7. ,, r 0o z <br /> �p C * <br /> CD. N —Q 0-< Q <br /> atT <br /> '' IT <br /> o to5. . m X <br /> • <br /> O8 <br /> ki./Q KCL-tiv_.,____, ,o, rn <br /> 10-29-82 k' o C <br /> Signature of Owner or r*Date <br /> Remarks l' 7 /Dyit- x <br /> fft <br /> cc�� :k II <br /> ✓. 2 z:0-1-� Cam... ° <br /> } /1-ice �c�, or�L \°• 0000co rr <br /> Inspection Date //"' 0 0 ry rr <br /> Zoning Administrator o0cD00of/: <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <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 />