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iVa9 L-C'."� T <br /> Burnett County Office of Zoning Administrator 0 0 0 <br /> APPLICATION FOR SANITARY — LAND USE i— BUILDING PERMIT 3 \ <br /> d o 5j <br /> TO THE ZONING ADMINISTRATOR The undersigned hereby makes application for a Permit for the work described and located as < N .0 <br /> shown herein. The undersigned agrees that all work shall be done in accordance withI he requirements of the Burnett County Land Use m m <br /> Ina ROber.tat�r lmde, and with all other applicable Count Ordlnances and t laws and regulations of the State of Wisconsin. 3 a { W <br /> Ord y fi� g scons \L1 W <br /> — w <br /> .. ..... 'e'a' . . ...................... . . ...... .. .. ................................................................... .... _ <br /> m <br /> OWNER (please print) CONTRACTOR or SU RVEVOR or AGENT <br /> 2109 West 104th Street <br /> ADDRESS............................................................................ .ADDRESS............................................................................ <br /> Bloomington, MN 55431 <br /> ............................................................................ .......R'E' .............................................................................. <br /> ADDRESS ADDRES.S p` st <br /> 2- <br /> PHONEE' <br /> .......... <br /> �. <br /> PHONE. .................................................................. . <br /> ............. WE.....L.L...DRI.. . .LLER. . ............................................................. `S <br /> PLUMBER <br /> O \} <br /> .. ...................................................................................... .ADD........R..ES...S.............................................................................. n L 0l� <br /> ADDRESS m <br /> O <br /> ........................................................................................... .PHO......NE..................................................................................... i o' <br /> PHONE Z N m <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details """ o <br /> New BuildingType of Construction: No. Bedrooms .............................................................. <br /> Addition Septic Tank Size Gals. .......... i <br /> .......... <br /> Sanitary .......... Size .............. ft. x .............. ft. .......... <br /> Fillings Grading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area ........................................... Soil Type .................................... C i <br /> p <br /> Mobile Home .......... Slope .......................................... ^ <br /> Privy .......... 3. Use (describe exactly, 1 -family Pere. Rate ................................... <br /> Well .......... home,garage, motel, etc.) Dry Well .......... 9� <br /> subdivisionSeepage Trench .......... C <br /> Camping Unit .......... ............................I....................... Privy r <br /> """"- <br /> .....X... .................................................... <br /> . <br /> Seepage Bed ......... -'C <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc-, should be sketched in Fig. A. Include road <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- 27 <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING I < <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. q0 o � <br /> ---------------------------------------------------------------------- l_ <br /> 5. Lot Size: Fig. A. 6. Location: <br /> .............. ft. x .............. ft. – ............................... sq.ft. Lot..3.v...CSM Vol...3�...P.a9e..la...................., E E� <br /> 3 <br /> n <br /> Application for land use camping permit rf o o' <br /> from / s � /`1 �� to oIV ` at <br /> crate <br /> \ <br /> ate date o <br /> 0 <br /> F <br /> y <br /> �\ z <br /> ~J a <br /> z <br /> 0 <br /> i� <br /> (n r U rn to Z <br /> ry N d n — 5 m <br /> o _. � mom <br /> Zoo' ag77 <br /> o O R a v 3 <br /> fA .D <br /> Q <br /> Z <br /> T D : <br /> . of .wner.... ............................................ .........✓ ....A................. O :); . C <br /> Signature Oor Agent Date .L <br /> Sem z 3'3 . ua c Sbsg „ x v: M <br /> Remarks . :................. .....1......... .............................. ............................................................................ <br /> ........................................................................................................... <br /> ' � l : m <br /> Inspection Date 'N^ m <br /> . ................... o 0 0 0 <br /> Zoning Administ ator F,/ y <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 systerns, a copy of the percolation test must he attached to <br /> this application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or stair 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 lie made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />