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Burnett County Office of Zoning Administrator SC F o <br /> APPLICATION FOR SANITARY - LAND USE - BUILDING PERMIT 3. ; <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and '2 <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the p <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, p a <br /> RODNPY D. L OKIK-"N A.T .EA 3031i� COST. INC ................ F A <br /> .... . . ........................................................................... ..... ................. . . . .............................. A <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT ^ Q <br /> 435 E.MIL'1. AVE. DP.O.•BOX...71.......................................................... �J <br /> ADDRESS ADRESS <br /> A <br /> FT ATKINS ON, ,,jL. $3538 SPOON' aa... .L..rl !:801....................................... _ <br /> ....................... ......... ........ ... .............. ........ ................. <br /> ADDRESS ADDRESS �Q -� <br /> /i /.:.... .. 3..:-.. a .............. .....6.3.s:77195................................................................ <br /> PHONE PHONE <br /> ARLYN J. IFLM `•oO <br /> ............... <br /> PLUMBER WELL DRILLER <br /> 4801 .......................................................................................... ? <br /> ADDRESS ADDRESS G <br /> ct c <br /> PHONE PHONE Z <br /> DESCRIPTION 4. Sanitary Facilities: ° o 0 <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details •'2""' c <br /> New euudmrr No. Bedrooms ` J <br /> .... Type of Construction: $ i <br /> Addition ................................................... Septic Tank Size Gals. ..7.rj0 i ,.! <br /> .......... 1 <br /> Sanitary .......... Size .............. ft.x .............. ft. ; <br /> FillingiGrading .......... Height............. Stories ............... 4a. Absorption Field,Site: <br /> Moving .......... Area Soil Type ........SAND................. r <br /> ........................................... Slope o <br /> Mobile Home .......................................... » <br /> .......... , <br /> Privy .......... 3. Use (describe exactly,'1 -family Perc. Rate ................................... o <br /> Well <br /> Well .,,,,,,,,, home,garage, motel,etc.) Dry We419Z <br /> Subdivision Seepage Trench .......... c i <br /> Camping Unit .......... ................... ... ..... .... ................ Privy .......... <br /> .. Seepage Bed .......... <br /> ------------------------------------------------------------- <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. C <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is located at IfJ g <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. : I a 0 <br /> ---------------------------------- ----------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: \ <br /> ................ ft. x .............. ft. - ............................... sq.ft. ............................................................................... i <br /> yl< S otthecK 8 3 �9 ' o� SES- f6 <br /> P 0 <br /> SEE ATTACHED SHEET. N ` 0 <br /> o n <br /> o _ <br /> O <br /> F <br /> o' <br /> - � Z <br /> tc. � a <br /> o6e <br /> Din MinrD co co -0 <br /> `. 0 C m N o C c <br /> 0 r^or 0 - -. m <br /> p � tp <br /> 0 o D ' <br /> o �� y SL <br /> o a : y <br /> o c o m <br /> 9 <br /> 8/9/88 r, ? <br /> c <br /> .... .... .. .. . .. ............................. ...................................... w C <br /> rn <br /> Sig ture o er or Agent Date <br /> o , <br /> o . o <br /> 8 o <br /> _ In <br /> N Q N <br /> .....�.../J. <br /> Inspection Date .................. `�C. m <br /> Zonin Adminis a r s��) 8889 8 8 in <br /> NOTE: A preliminary site inspection must be made and site appr al 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 it 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 />