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Burnett County Office of Zoning Administrator ZI' <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT m 3' o <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 n <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws nd 3 <br /> regulations of the State of Wisconsin. •+ n <br /> Vii' L?..LA.,TULIP .A.. NL . A H4'ORKSCONSTLC. A <br /> ........... . . . ... , T . ... . <br /> OWNER fpeaw 1 9q� <br /> Z <br /> print) CONTRACTOR or SURVEYOR or AGENT <br /> STdAR RT BOX 317 P.O.BOX 71o ct <br /> ................................................ ...... <br /> ADDRESS ADDRESS ............. <br /> ......SPOONS .'lt....1.1ji..54801..................................... . . . . ...................................SPOONEONr '.tdl 55480101 ; <br /> . ....................................... ...... <br /> ADDRESS ADDRESS <br /> ..................715-6.3.5....7.5.9.5............................ ...... <br /> PHONE PHONE <br /> C <br /> PLUMBER WELL DRILLER .� <br /> .................... .................................................................................... ....... <br /> ADDRESS ADDRESS '— <br /> O <br /> ........... . ....... H.0............................................................................. ....... <br /> .............................................. .................. ........ . O rC <br /> PHONE P.HONE Z r <br /> DESCRIPTION 4. Sanitary Facilities: o c o <br /> No. Bathrooms ` . <br /> 1. Work: 2. New Building Details .Q. 0 <br /> New Building .......... Type of Construction: No. Bedrooms .. .3....tic Tank Size Gals. 200 <br /> ;— <br /> Addition .......... .................................................... Sep <br /> Sanitary j... Size .............. ft. x .............. ft. .. ....... i� .� <br /> ""' Absorption 4a. Abion Field Site: <br /> Filling/Grading .......... Height............. Stories ............... <br /> MovingArea ........................................... Soil Type ............................. ....... o <br /> .......... Slope ................................ ....... <br /> Mobile Home .......... r <br /> .. <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ........................... ....... <br /> 0 <br /> Dry Well T <br /> Well .......... home,garage,motel,etc.) " """' — <br /> 0 <br /> --Subdwlelon-- Seepage Trench .. ....... o : <br /> Camping Unit Privy .. ....... <br /> Seepage Bed 3.75 0Q <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fi . A. <br /> _ C <br /> Include road setback,side and backyard dimension and location and setback from all bodies of water. If property is loca ed at <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersec ion. Z <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. : -c- 0 <br /> --------------------------------------------------------- ---- — <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. . ............................... sq.ft. ...................................................................... ........ <br /> SEE ATTACHED SHEET o' <br /> o D <br /> Z <br /> 0 <br /> �11 0 <br /> ll F <br /> ✓7 J <br /> a <br /> i m <br /> Z :7- <br /> 0 <br /> A <br /> a <br /> b <br /> m <br /> M <br /> c 1. w m n W co m <br /> 0r ,, < oo0 -' — m <br /> LD. n — n m a a y <br /> < d C J <br /> 8 w o i: 'z o � m 7+ <br /> oi»o •2 D � 1 <br /> — n : 9 <br /> m <br /> n o 0 <br /> SEPT 10,1987 " o <br /> ..... '......................................... . .......................... p <br /> )nature of Owner or Agent Date S <br /> marks m <br /> N <br /> ~ ' N <br /> ........................................................................................................................................................................... ...... <br /> O . S <br /> O : <br /> ................................................................................................. ... ................. ................................ .... T <br /> i.�4N.1.Y.1t. . . . Vd N 0� N "' N Imrf <br /> ction Date ....................................... .. .......:..... . O: v, N N O O Ut <br /> Y71....... ...... <br /> Zoning Admini rator U <br /> 888 S S 8 w <br /> DOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary f ci lities before construction <br /> an begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this ap lication before a permit will <br /> 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 /> voked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans o specifications shall not be <br /> tde without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE ANDA PROVED. <br />