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ACounty + Office of Zoning Administrator 0 0 <br /> APPLICATION FOR SANITAkY —s LAND USE — BUILDING PERMIT 3. <br /> TO THE ZOIyI�G ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as 0 <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use CD c <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> O <br /> ArtAndrea....................................................... ............................................... o <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a Cl CD <br /> Grantsburg, WI 54840 Q <br /> ADDRESS............. .............................................................................. <br /> ADDRESS v C � <br /> N Yt <br /> ........................................................................................... ........ADDRES-E-S-S............................................................ <br /> .................. :� <br /> ADDRESS � <br /> none Aa P <br /> P......................................................................................... <br /> PHONE HONE kD <br /> Donald Daniels <br /> .......................................... ...... ............ <br /> PLUMBER WELL DRILLER :X3 <br /> Box W Siren WI 548..2 <br /> o <br /> .......... <br /> .................................... ...................................... ................................................................................. <br /> ADDRESS ADDRESS :N 0 o <br /> 349-53 3333 64 or 46 2 ;W =t <br /> ....................... .-.... 0 .�....PHONE.........................................:.... ....................................... o o <br /> PHONE Z h r <br /> DESCRIPTION 4. SanitaryFacilities: 0 <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details 0 <br /> New Building Type of Construction: CD <br /> No. Bedrooms .......... :� -0 <br /> Septic Tank Size Gals. h <br /> Addition """"" < <br /> ....... ...................... ..................... . : <br /> ... ... ... .. <br /> Sanitary ....x... Size .............. ft. x .............. ft. Holding tank 20-00" • <br /> Filling Height............. Stories ............... 4a. Absorption Field Site: <br /> g Soil Type o <br /> Movin Area ............ ..... <br /> .......... <br /> o <br /> Grading Slope .......................................... <br /> .......... <br /> Mobile Home .......... 3. Use (describe exactly, 1 -family Perc. Rate ................none........ p, <br /> PrivyDry Well <br /> ,.......•, home,garage, motel,etc.) """"" �u <br /> Well Seepage Trench .......... v <br /> .......... .................................................... . <br /> — Subdivision Privy <br /> b ' <br /> .......... <br /> .................................................... <br /> Seepage Bed p <br /> ————————————————————————————————————————————————————————————— <br /> Location of proposed structures and existing structures,well,sewage systems, roads,etc.,should be sketched in Fig. A. Include road c <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- �� Q <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING , <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. �G o' <br /> ---------------------------------------------------------------------- © <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... sq.ft. ............................................................................... o % <br /> Cn <br /> CD <br /> N 0 <br /> o c <br /> cc <br /> N <br /> h <br /> C� <br /> N <br /> j�iD ° 1 t/'� /�k�SC 55/►1e✓� �vr �w.(�r�cQ c-<�^G�2�- -n <br /> i°Q <br /> UQfCY• pi.. /i'1' n �� 0 <br /> �}SSG�SS/7'�a+/f r5�w,•., (<.��Pi�•— (�Or^�N.-f"'� � c <br /> • � m <br /> R: m <br /> I��Yy kx-- sec.4a T3s tiRl8W oo <br /> C'SDX L Ll y M to 01r :� M Z <br /> c w mCD <br /> Webs-fir vo= 5 t� > C Q Q h'Q <br /> N _. <br /> off-C 3 `-{°I Co. (zd- nrl o v_ y m <br /> Z o o fD " 70 <br /> o <br /> � <br /> cn <br /> J.� o M <br /> 10/21 /83 �� p <br /> Signature of Owner or Agent Date rt — <br /> x 70 <br /> Remarks -n 0 <br /> m <br /> :\ u <br /> :O <br /> Q ;\o � ED � TI <br /> Inspection Date ....................................... 9 /- Clo 0 0 0 o m <br /> p ! �✓..........I.g .r.j................... 000000m <br /> Zoning Ad inistrator o 0 0 0 0 o cn <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 be made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />