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Burnett CGuntyOffice of Zoning Administrator d o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 ow <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for 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 m <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> d O <br /> ..............DARA.EL...SOA,�tEN........................................ ....................A.UYN... .....HLIS2................................... N <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a <br /> 8100 82nd AVE N0. P.O.BO11 71 — <br /> ............................................................................ .................................. <br /> ........................... <br /> ADDRESS ADDRESS » ' <br /> ...... ......D7.N...55445..................... .......... ............................ s <br /> ADDRESS ADDRESS <br /> .. ........ . . <br /> .........7..�5.-6.3.5...759.5. <br /> ..................................... <br /> ... ............ ..... .... <br /> PHONE PHONE <br /> ARLYN J. HELM � LA <br /> .......... <br /> PLUMBER WELL DRILLER :fit <br /> P.O.B0 ..�/l ................................... ............................................................................................ _ g <br /> .1. .............. . v <br /> ADDRESS ADDRESS <br /> SPOONED.....WI...54801.............................. o v) <br /> c� <br /> .................................................................................. ° ° » <br /> PHONE PHONE Z H r <br /> DESCRIPTION 4. Sanitary Facilities: ; ^ o ° <br /> 1. Work: 2. New Building Details No. Bathrooms .......... L 0 :al <br /> New BuildingT No. Bedrooms ° ✓/ <br /> .......... ype of Construction: .......... <br /> Addition Sept' Tank Size Gals. p0 » <br /> vv..... UMP TANK SO O <br /> Sanitary ....Il.... Si ze .............. ft. x .............. ft. �Q <br /> Filling/Grading .......... Height........... Stories ............... 4a. Absorption Field Site: <br /> Moving Area Soil Type ...........SAND.............. � <br /> .... ..... ........................................... i <br /> o <br /> Slope ...................... ... » <br /> Mobile Home ........... <br /> ........., ...... <br /> Privy .......... 3. Use (describe exactly, 1 -family <br /> Pero. Rate .................C <br /> ........... <br /> Well .......... home, garage, motel, etc.) Dry Well .......... <br /> Subdivision Seepage Trench .......... i <br /> Camping Unit ......I... .................................................... Privy ..... ... <br /> .................................................. .. <br /> Seepage Bed 4.10...SQ FS <br /> -- T <br /> _________-________________________________________ __________________ -C- do 1 <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc, should be sketched in Fig. A. Incude road t <br /> Q <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway Inter- U,I rection, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING = <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. w p <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. . ............................... sq.ft. ............................................................................... <br /> N <br /> m <br /> SEE ATACHED <br /> N o <br /> O 3 <br /> 7 _ <br /> 7 <br /> O <br /> O <br /> S <br /> Z 1 <br /> O <br /> d <br /> m <br /> M e r- M � d m Z <br /> G N c N <br /> N v m <br /> mm <br /> C)Z o D nDo <br /> O 7 n o <br /> fA <br /> JIng <br /> 0 . <br /> ...... 8'..8............ S o A <br /> Signature of Owner or AgentDate (� 1 <br /> J' 31 <br /> X <br /> / . . <br /> Remarks ......../1...�...Cfl-U'.��..................................................................................................................... m p <br /> ........................................................................................................?tc <br /> .................`..I./.}� --^^1�. .................. .. ........... <br /> Inspection Date ...7.� — . � .. ... .. . .............. U N mZoning Administr org 0 NOTE: A preliminary site inspection must be made and pproval granted on all structures involving sanitary foci ics <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 it misrepresentation of any of the information conveyed here- <br /> with is found to exist. Changes in plans or specifications shall not he made without approval of the Zoning Adminlstratoi . <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />