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Burnett County Office of Zoning Administrator �' o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT m 3, <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the ^$ C <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulationsof the Stateof Wisconsin. '; a <br /> KA . ...:30MEIS :3 A,,M,.,EA 2THiy0:3KS....CiON5T.r....T. .Sr..^..... F q 3QQ <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT 1 <br /> 3311 33rd AVS SO. P,O.BOX 71 <br /> ADDRESS............................................................................ .ADDRESS................................................................... ... v � <br /> MINNEAPOLIS , MN 554 SPOONE3tI54801 <br /> 06........................... ........ . .... . ... <br /> . ............................'...... <br /> ADDRESS ADDRESS.. - <br /> ........................................................................................... . .PHON. . ..E............................................... . <br /> .................................. l <br /> PHONE ; <br /> A3LYN-J. HELM 6 59.......?......5.............................................. <br /> PLUMBER WELL DRILLER ' <br /> .................................... ............................ ........................................................ ...... o <br /> ADDRESS ADDRESS <br /> o <br /> .......b35-7595 <br /> . .......... ............. .................................. ......... ..................... ............ ... ...... zo <br /> PHONE PHONE <br /> DESCRIPTION 4. Sanitary <br /> Facilities: ° o <br /> 1. Work: No. Bathrooms v - <br /> 2. New Building Details •• e <br /> New Building .... Type of Construction: No. Bedrooms .. `•O' <br /> Addition .................................................... Septic Tank Size Gals. ,5••• < <br /> .x.... <br /> Sanitary ..... .... Size .............. ft. x .............. ft. . <br /> Filling/Grading .......... Height........... Stories ............... 4a. Absorption Field Site: <br /> MovingSoil Type .............................�...... <br /> .......... ........................................... r- i <br /> Area <br /> o <br /> Mobile HomeSlope ................... ... + <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ............� 3 n <br /> Well .......... home,garage, motel, etc.) Dry Welt E E i <br /> Seepage Trench 0 <br /> Subdivision ......,,,, ' o <br /> .................................................... <br /> Camping Unit Privy ,t�J <br /> .......... .................................................... <br /> Seepage Bed ------1-y. 'Q L', :: ? ;� <br /> - <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. <br /> Include road setback,side and backyard dimension and location and setback from all bodies of water. If property is Iocat#d atLr <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersection. N <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o <br /> --------------------------------------------------------------------- a:o <br /> 5. Lot Size: Fig. A. 6. Location: I <br /> ................ ft. x .............. ft. — ............................... sq.ft. .......................................................................;... ... ,,: <br /> :11 <br /> SEE ATTACHED SHEET <br /> n <br /> D. <br /> I � <br /> 0, D <br /> 0 <br /> —yam,a o <br /> '. £ <br /> ill � <br /> '.. E1P i J <br /> T <br /> a <br /> 0 <br /> O <br /> I d <br /> J <br /> tG <br /> m <br /> N C C N N p C do <br /> a <br /> I, NN6'< — dry dtl � <br /> Om `< m pmtp <br /> Z^ O 1 <br /> o � D <br /> o c m <br /> � 0 : D <br /> T C <br /> 9 MAY 23,1988 <br /> ..�..... ....... ...................................... <br /> m <br /> m <br /> Signature of Owner or Agent Date o <br /> m m <br /> Remarks <br /> e n <br /> 0 <br /> ...................................................................................................?ro,,l <br /> ............... ... ..... o <br /> "�'C NT <br /> Inspection Date ....................................... iuF c.t. ....... 11n <n o o m m <br /> Zoning Adminis atorS S S S S <br /> NOTE: A preliminary site inspection must be made and site agranted on all structures involving sanitary facilities before construction <br /> 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 <br /> be issued. Do not purchase or install a septic tank, do any plumbing or start any building until a permit has been issued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or specifications shall not be <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />