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7 <br /> Burgett Cownty . _ Office of Zoning Administrator d o z <br /> 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as O \ <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use 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 /> JOHN HILL y a) 0 <br /> C <br /> OWNER (please print) CONTRACTOR or,SURVEYOR or AGENT a CD <br /> 10809 Hollywood Blvd. _ <br /> .......... <br /> ............................................ a <br /> ADDRESS ADDRESS <br /> Coon Rapids, MN 55433 <br /> ADDRESS ADDRESS <br /> ............ <br /> .................................................... ............................................................................ <br /> PHONE PHONE <br /> Donald Daniels <br /> . ................... . <br /> ........... <br /> PLUMBER WELL DRILLER ro <br /> Siren, WI 54872 <br /> DR. ESS ................................................ ADDRESS.... ...... . .. ......................................................................... o <br /> AD <br /> 715-463-2333 h o <br /> ............. o' <br /> PHONE PHONE z <br /> DESCRIPTION 4. Sanitary Facilities: ° 0 ° <br /> 1. Work: 2. New Building Details No. Bathrooms 9 7 <br /> 0 . <br /> New Building .,•„•••.. Type of Construction: No. Bedrooms 3.... h v <br /> Addition „•••,,,• Septic Tank Size Gals. .......... •W <br /> ........................ ....................... .. c <br /> Sanitary X...... Size .............. ft. x .............. ft. 2000 gal holding—tank ' <br /> Filling .........• Height............. Stories ............... 4a. Absorption Field Site: <br /> V <br /> Moving Area Soil Type .................................... i[, r........................................... <br /> d O <br /> GradingSlope .......................................... i <br /> Mobile Home Perc. Rate ................................... ' <br /> .......... 3. Use (describe exactly, 1 •family <br /> F <br /> Privy .......... home,garage, motel, etc.) Dry Well <br /> Well Seepage Trench .......... ' <br /> Subdivision .................................................... Privy <br /> .......... .......... <br /> .................................................... <br /> Seepage Bed .......... Zl <br /> -- --------------------------------------------- <br /> Location of proposed structures and existing structures,well,sewage systems, roads,etc.,should be sketched in Fig. A. Include road `% a. <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- � fl <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. �. <br /> 0 <br /> ---------------------------------------------------------------------- <br /> o <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ..21.0........ ft. x .1.0.Q...... ft. — ............................... sq.ft. ....WQQ.d ...................................................... <br /> See Attached CD <br /> N p' <br /> O O <br /> N <br /> r? <br /> O <br /> ± 7. <br /> �•') _m <br /> CD <br /> z <br /> 0 <br /> d <br /> c <br /> m <br /> X N r :F N m z <br /> CD CED . I CD <br /> d <br /> z oo' C" m <br /> o 6 : —_ 70 <br /> cn `a —i <br /> o <br /> _ _ M <br /> 74A � ' <br /> . .....ignature of Owner ort Date X <br /> n :0: m <br /> Remarks ................................................................................................................ ,. <br /> ......................................................... <br /> m <br /> CD <br /> ........................................................................................................................................................................................ <br /> u <br /> ......................................................................................................... ..................................................... <br /> Inspection Date ....................................... rkPo/ .C .. ....?�1...................... o o cn m <br /> N <br /> Z. cc <br /> ������ o 0 <br /> Zonin AdminiS rator . C 0 0 0 o N <br /> TOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> efore construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> lis application before a permit will be issued. Do not purchase or install a septic tank, do any plumhing or start any build- <br /> ig until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> lith 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 />