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Burnett County Office of Zoning Administrator iv 0 0 <br /> 'APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as < H <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m c <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 o, <br /> m O <br /> owv€R'IpleaODNEY.,STAPLES........................... A.M.EARTHWORKS CONST INC N <br /> e print) CONTRACTOR or SURVEYOR or AGENT m m <br /> ....... ...........ROUTE...t ..1............................................... P.O.BOX JlOO <br /> ...................................................... <br /> ADDRESS ADDRESS _ <br /> " BSTFSPOONE3s....'JL..54801.................................. f <br /> ADDRESS ADDRESS ' <br /> 715.-635.,7595............................................. <br /> PHONE .... 00 <br /> PHONE <br /> A <br /> RLYN J. HELM pp <br /> ...................................................................... .WELL... .. D.. ......R.ILLE........R..................................................................... <br /> PLUMBER <br /> P.,O,..BOX....71.e...SPOONER.r...WI...S.4801 <br /> ........................................................................................... o <br /> ADDRESS ADDRESS O <br /> n o <br /> ........................................................................................... ............................................................................................ Z H� <br /> PHONE PHONE <br /> DESCRIPTION - r <br /> 4. Sanitary Facilities: <br /> 1. Work: 2. New Building Details No. Bathrooms <br /> New Building .......... Type of Construction: No. Bedrooms o <br /> 3 i <br /> addition .,....,,.. ........................... .. Septic Tank Size Gals. .IO.Op < <br /> Sanitary X.... Size .............. ft. x .............. ft. .. ....... <br /> Absorption Field Site: <br /> Filling/Grading .......... Height............. Stories ............. . <br /> Area Soil Type .................................... r <br /> Moving .....I. .. ........................................... <br /> Mobile Home ........ . Slope .......................................... o <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Well .......... home,garage, motel, etc.) Dry Well .. ....... — <br /> Subdivision .......... .................................................... Seepage Trench .......... <br /> Camping Unit ,,,,,,,,,, Privy .......... <br /> ............................................. ...... <br /> Seepage Bed3 <br /> -------------------------------------------------- —_------- .-- <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched in Fig. A. Include road <br /> J N <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- °- <br /> section, show the Intersecting highways and the setbacks required along them and at the Intersection. CLEARLY LABEL EXISTING <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS 0a' <br /> I � <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... sq.ft. <br /> .............................................................................. <br /> 0 <br /> m <br /> SEE ATTACHED SHEET <br /> N c <br /> o <br /> 3 <br /> U <br /> O <br /> 1 s <br /> z <br /> is <br /> d <br /> X) (n r eofn Z� <br /> tD Vd C 4 � � N <br /> _ £ <br /> O U < c M <br /> Z O O m n m <br /> O _O n ' J7 <br /> �� o � <br /> o <br /> �cr m <br /> Signature of Owyer or Agent Date <br /> X <br /> Remarks ................................................................................ . . ...................................... � m <br /> D <br /> ........................................................................................................................................................................................ <br /> �—u <br /> ........................................................................................................ <br /> 9.................. ................. J: <br /> C - NmN N <br /> InspectionDate ....................................... 21p,l/.....:.............. .. ...... � .............. u, �, o o v, rn <br /> Zori Ad nistra r 8 0 0 ' 8 8 N <br /> OTE: A preliminary site inspection must be made an 1 site approval granted on all structures involving sanitary facilities <br /> `ore construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any bulid- <br /> 'ttil a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here <br /> - <br /> found to exist. Changes in plans or specifications shall not he made without approval of the Zoning Administrator. <br /> `tER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />