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Burnett County Office of Zoning Administrator a o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> < ° <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit 's the work described and located as <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use � c <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> .E O <br /> Michael Dasovic O <br /> ....................................................... ........... . Y'O"'.... ....................................... <br /> 0 <br /> OWNER (please print) CONTRACTO. . R or SURV EVOR or..AG... ENT s <br /> 520 Stewart Ave. a i3 <br /> ............................................................................ ................................................................:........... :< N <br /> .. m : I <br /> ... ................................. ................ w <br /> ADDRESS t. Paul,..MN 55075 ADDRESS ........................................................................... <br /> ADDRESS i <br /> 612-455-4969 ;S <br /> :r <br /> ................................................................................:........... <br /> ...................................................................................... w <br /> PHONE PHONE :rn <br /> Donald Daniels .......... <br /> ............................................................................ ................L'L"E.. o <br /> PLUMBER WELL DRILLER '~• <br /> jr i i a <br /> Box W Siren, WI 54872 p <br /> ADDRESS ADDRESS <br /> 715-463-2333 ° <br /> ................................................................................ <br /> . Z o <br /> PHONE PHONNEE ' <br /> DESCRIPTION0 <br /> 4. Sanitary Facilities: ° <br /> ° o <br /> 1. Work: 2. New Building Details No. Bathrooms ,xXxx <br /> New BuildingNo. Bedrooms ° <br /> .......... Type of Construction: � � ' <br /> Addition ..... . .. 4 . ...................... Septic Tank Size Gals. .......... <br /> D m <br /> Sanitary ....X... Size .............. ft. x .............. ft. <br /> Holdi tank .200.0 J ` <br /> Fillin (Gradin 4a. Absorption Field Site: d <br /> e e Height............. Stories ............... <br /> .......... Area Soil Type ........................�........... o <br /> Moving ........................................... <br /> Mobile Home .......... Slope .............. ................i........... ;.p. <br /> Perc. Rate .......................i...........Privv .......... 3. Use (describe exactly, 1 -family <br /> r i <br /> Well <br /> We — <br /> Well home,garage, motel, etc.) Dry I �••••����• g : : <br /> Subdivision Seepage e Trench <br /> ' <br /> Camping unit 8irig7era .cabin <br /> Privy ......... cP <br /> .......... Seepage Bed ......... <br /> ----------------------------------------------------- --------- --- <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc_ should be, sketched In Pig- A. Include road P• <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a hlghwdy Inter- r" n <br /> section, show the Intersecting highways and the setbacks required along them and at the intersecfion. CLEARLY LABEL EXISTING W <br /> .o <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> ---------------------------------------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: 'm <br /> ................ ft. x .............. ft. — ............................... sq. ft. i > i <br /> • a 11 rte, <br /> ' rel <br /> i <br /> c- <br /> i1 - <br /> . � . o <br /> 1 <br /> 2 <br /> pa <br /> , o <br /> Jl � <br /> m <br /> Co <br /> W <br /> IIC <br /> M cn r _0 m Z <br /> C0 <br /> ry c m <br /> (paa � 2 F <br /> "O (Nlr <' C c cm <br /> Z 0 3. M y ¢ T <br /> O nam 77 <br /> v — 3 <br /> 3 <br /> �.. ............... .. ................ p <br /> Signature of 0 ner gr A ant Date <br /> o C <br /> /y �j-� Lr2 ................................................................................................... <br /> Remarks .. .......f........ ........:::.................... m m <br /> : <br /> u <br /> ............................................................................................................. : <br /> ...... ........................................... <br /> Inspection Date ...... :...:. .G:........... X16 "1i U N o 8 0' N m <br /> Zonin Administrator s 8 8 8 8 8 8 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 systems, a copy of the percolation test must be attached to <br /> this application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start 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 be made without approval of the Zoning Adm inistratw. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />