2012/12/07 - SANITARY - SAN - Other (3)

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Burnett County Office of Zoning Administrator ' z m o APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a _ o Permit for the work described and located as shown herein. The undersigned agrees that all d ; work shall be done in accordance with the requirements of the County Zoning Ordinance, F �� Sanitation Code, and with all other applicable County Ordinances and the laws and regu- lations of the State of Wisconsin. a � \ O WHISPERING PINES U. METHODIST CAMP 3 :v <° . . . . . Ha=7. Hogg . . . . . . . . . . . . . . . . . . _ — Owner or Agent (please print) Contractor or Surveyor G Frederic W-A 5(+837. . . . . . . . . . . . . . RFD. . New. Richmond,. Wi .540.17. . . . . Address Address ' a � 327 8148 246 6265 „ A e Phone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Phon � � ?b• Kermit Larson not needed \ !� Plumber. . . . . . . • . . . . . . . . . . . . . . . . . . . Well Driller Rt 1 Luck Wi 54853 -- o . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Address Address 0 6485480 (5580) -- � - . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ph.one X. . . . . . . . . . . . . . . . Z Phone p: r . DESCRIPTION 4. Building Details 7. Sanitary Facilities 770 " Typg of Construction No. Bathrooms . . .z. . Z Z o 1. Work . . . .r.. . . . . . . . . . . . . . . . . Dishwasher . . . New Building Size 28. . ft. x . . . . ft. Garbage Grinder . . .... C\ ,� Addition . . . . . . Height . 12 . Stories . . .1 . . Autom. Laundry �1 Sanitary . . . . . . Area . .1152. g4 .ft. . . . . . No. Bedrooms . . . W Alterations . . . . . . Waste Disposal Systemr, o a Moving . . . . . . 5. Permits Required Septic Tank Size Gals./�60.�s Wrecking . . . . . . Subdivision . . . . . . Absorption Field Site Mobile Home . . . . . . Sanitary ype m m ' . . . . . . Soil T . . . . . . . . . . . . . . . . . . Privy . . . . . . Building . . .x Slope m m . . . . . . . . . . . . . . . . . . . . . . . y, fn 1 : Well . . . . . . Well . . . . . . Perc. Rate . . . . . . . . . . . . . . . . . Subdivision . . . . . . Other (Specify) . . . . . . Dry Well o 1 Conditional . . Seepage Trench 2. Classification Land . . . . . . Privy '/� Cr Zoning Dist. . . . . . . Seepage Bed �T A. o 6. Use (describe exactly, 1 -fam. - 3. Lot Size home, motel etc.LL FOR COMMERCIAL USE o ' ft. x ft. Kitchen Staff cabin plans Submitted . . � for summer use. Plans Approved . . . . . . --------------------- Location of proposed structures and r existing structures, well, sewage sys- uj: o tems, roads, etc., should be sketched G► in Fig. A. Include road setback, side Lc 0&Lsn and back yard dimension and location and setback from all bodies of water. rrcnn Di '9 If property is located at a highway in- _ a -} �,�, tersection, show the intersecting high- I �#— a_-r p E_:I ways and the setbacks required along > them and at the intersection. I s�pl PERMIT FEES cms..� IOC Subdivision . . . . . . . . . $15.00 Land Use . 1_.00 Building Sanitary . . . . . . . . . . . 10.00 +Q Well . . . . . . . . . . . 5.00 Sl7�rK tT �.,.q •L Septic Tank . . . . . . . . . 1.00 Y Combination Building, Sanitary and Well . . . . . . . . 15.00 s � g ge , 5w, ..r 4t . . ... . �a urf or AgfSnn� Date ynin dministrator InspectionDate ..............s................................... Inspector ................................................................................................ RemarksJ,t''.'.... ....r�. ..34,.. .73�. ../.��7.Q�.............................................................................. ................................................................................................................................................................................................ ................................................................................................................................................................................................ NOTE: A preliminary site inspection must be made and 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 aseptic 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 Administrator. SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED.