1983/10/18 - SANITARY - SAN - New Non-Press - 11126

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3urnett County Office of Zoning Administrator Cn v _ o 0 • APPLICATION` FOR SANITARY — LAND USE — BUILDING PERMIT ' o TO THE ZONING ADMINISTRATOR: T undersigned The hereby makes application for a Permit for the work described and located as shown herein. The undersigned agre-tb.at all work shall be done in accordance with the requirements of the Burnett County Land Use CD C I CD Drdinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 0- o o` LV 1 h 9 1 c .. OWNER (please pridt) CONTRACTOR or SURVEYOR or AGENT CD CD ............................................................................................ Q ADDRESS ADDRESS ADDRESS ADDRESS 'H E PHONE J��r. .................... ........................................ 'LUM WELL DRILLER CV ADDRESS ADDRESS :l h o . . ... 0 1 :n 'HONE PHONE DESCRIPTION z N 0 4. Sanitary Facilities: ° o 1. Work: No. Bathrooms 2. New Building Details 0 No. Bedrooms G -0 New Building .,,,,��... Type Construction: •••••••••• Addition Ih R I.v�1— Septic Tank Size Gals. : Sanitary %4:... .... .. x.. Size ... .... ft. x ..Zs ..... ft. Filling Height..........:.. Stories ............... 4a. Absorption Field Site: C Moving Area Soil Type .................................... : r o Grading Slope .......................... ............... - : .. ....... Mobile Home 3. Use (describe exactly, J fnr Perc. Rate ....... ............................ Privy •• ••• home,garage, motel, etc.) Dry Well ., Well � .. .................................................... Seepage Trench .......... `! Subdivision .....•.•.• Privy ........................................ -- -- Seepage Bed / • y.. _ocation of proposed structures and existing structures well, sewage systems, roads etc.,should be sketched in Fig. A. Include road Q11 setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING < STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. N o' --------------- ------------------ 5. Lo Size: Fig. A. 6. Location: I .�..��... ft. x .. :." ft. — ............................... sq.ft. '15 .............................................................................. N o o 0 0 0 CD ik Nam" 1 6 � U) r � c C c2 _ Cd CD m, Naas — o cn < ' p N ti G z O o (D Z. o ................................ ............,.................. ....... =.�.�.....�.y.....d-9_5 m signature of Owner or Agent Date ° p 17 ��- x iemarks ............. ....... .................................... .......................................................................................... m m CD CD ................... �?r?....Oz7 ..ttc¢ :c...z ..J ........................................................................................ ............ fr.:...! .v...L.. ............................. ..................V........................................................ N T nspection Date ... ......... ........................ e�!h? °..!...:.... ............... 0 0 o cn m Zoning Admi strator F J o 0 0 0 0 o N OTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities fore construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build- until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- is found to exist. Changes in plans or specifications shall not be made without approval of the Zoning Administrator. EWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED.