1986/07/24 - LAND USE - LUP - Other (3)

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—leo ? 3t?Yv z. Burnett County Office of Zoning Administrator 0 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 localed as 7 shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a a William F. Coulson Fir o .......................................... .......... . . . .................................................... _ OWNER (please print) CONTRACTOR or SURVEYOR or AGENT O. 1126„Knollwood•.Drive ....... ....... J ... ................................... ADDRESS ADDRESS River..Falls,.�?I...,54022 ADDRESS ADDRESS 715-425.-5505......................................................... ............................................................................................ I [ PHONE PHONE ........................................................................................... ......... . . . . ...................................................................... PLUMBER WELL DRILLER i- ... O ........................................................................................... . ...................................................................................... ADDRESS AD.. DRESS o ? ........................................................................................... . ............................... . . �. PHONE PHON....... E z r DESCRIPTION 4. Sanitary Facilities: ° o ° 1. Work: 2. New Building No. Bathrooms Details '""""' o E No. Bedrooms a N,fw Building .......... Ty a of C str Gt ion: """"" i Addition �{Yh $eck ( GO / Septic Tank Size Gals. .1........ ; ..... . ................. .. ................. Sanitary ......4... Size .....1Q.... ft. x .... ft. """" i Filling/Grading .......... Height........... Stories ............... 4a. Absorption Field Site: Moving .......... Area ........................... ............... Soil Type .................................... .......... i .O Mobile Home Slope .................................i........ _ _ 0 Privy ,......... 3. Use (describe exactly, 1 family Seepage Trench Well .......... home,garage, motel, etc.) Dry cWelle .................................... Subdivision """"' Camping Unit .......... .................................................... Privy ...... . ---------------- ------- Seepage Bed------ --- ce, Location of proposed structures and existing structures, well, sewage systems, roads, etc.,should be sketched in Fig. A. Include road 9J :� C :CJ setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter VVV a section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING I ��—, STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. J I�E o --- --------------------------------- iL i 1A0....- ft. x ....250.... ft. - ..250.00.................. sq. ft. La..Z.zk..&.19..Y.�J k.9W.. d1z....E.S.tdt... --- 5. Lot Size: Fig. A. 6. Location: e e 1......... Q, :(T� Govt. Lot 4, Section 29-T4ON-R16W and in the NW-4 of NE4, Section 32-T4ON-R16W To f / I I OaX,land, Cn _ 'G. Ru rf o I11 Il ( i�li wo / d � m m2 g : m 0 0? n � In y� May 6, 1986 p ... ...................... ........ ... .. ............... .•• 4....................� o C Signature of Owner or t Date X Remarks ................ ...../v.... ... >...... ... ;.......... ...................: ............................................ .......................................................................................................................'...... '_ ............................................................................................... ....... ................. _..................................... InspectionDate ....................................... ... .. .!/..:.(.... ... . .......... .............................. ...... o o U m Zoning A ministrator 8 8 8 $ 8 8 h NOTE: A preliminary site inspection must be mad d site approval granted on all structures Involving sanitary facilities 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 pldmbinq 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 We made without approval of the Zoning Adm inistrator. SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED.