1985/05/03 - SANITARY - SAN - Other

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Burnett County Office of Zoning Administrator tM o o APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as _ shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett Count Land Use c :(--Cs 9 9 q Ordinance, Sanitation Code,and�wital.]..other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3�'' ............ . ............ ../ L-..................................................... OW ER (please print) // CONTRR or SURVEYOR or AGENT n ..... .......^..Bcy�..il............................. ............................................................................................ � A DR ADDRESS i ) .....��....T .............. ..................................... ............................................................................................ . ADDRESS ADDRESS ' ................................................................................ PNE ........................................................................... .PHONE /V.C....5.........OfPQ....................................... ............... �v PLUMBER WELL DRILLER ...f/ ..C.. f1.'..`. ...f......Y.TE...................................... . . . . . ................................................................................. ADD SS ADDRESS :Cn 0 0 H . . ........ ........ ................................................... . .......................................................................................... P ONE PHONE Z D r DESCRIPTION 4. Sanitary Facilities: ° 0 0 1. Work: 2. New Building Details No. Bathrooms ....�.... :O New Building Type of $n ti n: No. Bedrooms .... .. i 'o .......... ��p +�, I Addition ....,..... ......L.v 1-y9Z�=D Septic Tank Size Gals. 7 v Sanitary Siae .y ft. x .. jam ............ ft. » � Filling/Grading ......... Height.... ........ Ston 5 4a. Absorption Field Site: i ............. Moving .... ..... Area .......�7✓.. �... Soil Type .................................... ' o Mobile Home .......... Slope ..............f.�.....�.y �/ 1: Privy .......... 3. Use (describe exactly, -famil Pend. Rate .......'/..'.y.�.7........... Well ,. o ara e, motel, etc.) Dry Well .......... a i v- Subdivision �g ng Seepage Trench .......... ^ i '• 1 Camping Unit ,,,,,,,,,, Privy .t.�... Seepage Bed ___________________ _________.A._. :N Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. Include road o. setback, side and back yard dimension and location and setback from all bodies of water. If property s located at a highway inter- — al.t'• section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING — •� i 5 - STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. T. O--------------------------------------- C ' 5. Lot Ste: Fig. A. 6. Lo ation: ,-,c ` ..[.1.:3....... ft. x ... ..�� ft. — ............................... s9.ft. /,?.(..�5<.L.....Y.CI:;e�C................................ E e /V1 of 0 1D hJ = 0 J / f} T iR.1 Z � d9 ami ,cir -a m t N _. C: d W Za 6 o on m . .... . ..z 5 ..... s..... \0 C as as o C igna o caner r gent ate X S m e arks ......................................................................................................................................................................... mp m ........................................................................................................................................................................................ - n : : : : p : M 6� N N m tet/ .............. Inspection Date ....................................... ..Qi!!?:G.'�. ........../. ... ....��. �4.1.................... : 1 8 8 8 8 8 8 m ZoningAdministrator Vf NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilitwq before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to this application before a permit will be issued. Do not purchase or install a septic tank, do any Plumbing or start any build- ing until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- with is found to exist. Changes in plans or specifications shall not be made without approval of the Zoning Adm inistratoi. SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED.