1983/09/21 - LAND USE - SUB - Certified Survey Map - 11070

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i I 1 Iurnett County- Office of Zoning Administrator v _ o 0 APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT . O THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as '< sown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m ,rdinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a .,. ...5...- c�2 .............................. , :., '. .. .. ....... � ..:.1 '.. y NER (please print) CONTRACTOR or SURVE R or AGENT aCD 5.1.q Q e< ........................ ........................................ .DDRESS ADD ESS .+ co ,.. _5 D'D' ..... 1�1� ................................................ ,DDRESS ADDRESS w� .6...'..7.y.76....................................................... HONE PHONE ............................................................................................ LUMBER WELL DRILLER ,DDRESS ADDRESS m L� 0 o r+ < o'. . ..... . . . . : HONE PHONE z N r DESCRIPTION 4. Sanitary Facilities: ° o ° Work: No. Bathrooms 2. New Building Details o New Building .......... Type of Construction: No. Bedrooms .......... ti Addition .................................................... Septic Tank Size Gals. .......... h .......... < Sanitary .......... Size .............. ft. x .............. ft. .......... Filling Height............. Stories ............... 4a. Absorption Field Site: SoilType .................................... r Moving .......... Area ........................................... o GradingSlope .......................................... Mobile Home .......... .......... 3. Use (describe exactly, 1 -family Perc. Rate .............Privy .......... home,garage, motel, etc.) Dry Well Well Seepage Trench .......... '• ................................................... Privy Subdivision .................................................... . . Seepage Bed .......... .ocation of proposed structures and existing structures,well,sewage systems,roads,etc.,should be sketched in Fig. A. Include road J aback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- a action, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING y TRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. ---------------------------------------------------------------------- �J o Lot Size: Fig. A. 6. Location: ................ ft. x .............. ft. — ............................... sq.ft. ............................................................................... CD N o O G� cn r .,T M 11 y CD :\ S 0 CD Q'N CD Cnr vgCncoz III)gipr�- Q �Cr= � _ `' CD tt —} Lc. N a a•< � m z o o m 70 0 3 o C CD ID I............. .�............. : o signature of Owner or Agent Date X 70 iemarks -n M 0 Co ' ....................................................................................................................................................................................... -- N, u 0000Cnm nspection Date.:..................................... : o 0 0 0 0 o m Zoning Administrator : : 0 0 0 0 0 o cn OTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities afore construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to its application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build- g until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- ith is found to exist. Changes in plans or specifications shall not be made without approval of the Zoning Administrator. SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED.