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Burnett County Office of Zoning Adminis rator 0 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> 0 <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 Yl <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wis onsin. 3 a ZJ <br /> JOHN BLANCHARD ARLYN J. HELM <br /> L <br /> .q'ri .............................................................. ............................................................................ <br /> OWNER (please print) CONTRACTOR or SU RVEVOR or AGENT a � i <br /> 7.400...C.,.ii?...3.6th..ST.,........................................ ............P.O.BOY...71........................................ .......... d � y <br /> ADDRESS ADDRESS <br /> Z?A.V1+.�... "L <br /> ...33314 ......SPOONER ....`' I 5LP801 <br /> ........................... .......... a <br /> ADDRESS ADDRESS <br /> PHONE PHONE .......................................... .......... <br /> J <br /> B.PLYN...J.r...HELM.................................................. G7 <br /> ............ ................................................................... . <br /> PLUMBER WELL DRILLER :O'O <br /> SP.QO.NER. ... 1........................................................... �1 p Z <br /> t ................................................................................. ...I...... <br /> ADDRESS ADDRESS A <br /> ....................................... 0. <br /> o <br /> o a <br /> PHONE PHONE ZH r <br /> DESCRIPTION 4. Sanitary Facilities: ° o 0 <br /> 1. Work: No. Bathrooms 13 <br /> 2. New Buildin Details ••• •••• !''� <br /> New Building T g No. Bedrooms .3.... 0 <br /> g ype of Construction: ],000 <br /> Addition .................................................... Septic Tank Size Gals. < <br /> .......... <br /> Sanitary .......... <br /> Size .t.......... ft. x ...s ........ f.. 4a. Absorption Field Site: <br /> Filling/Grading .......... Height............. Stories ............ .. +L� : ' <br /> Moving .......... Area ........................................... Soil Type .............v... <br /> ....... .......... r <br /> Mobile Home .......... Slope .............a............... .......... 0 <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ..........3............ .......... <br /> Well .......... home,garage, motel, etc.) Dry Well .......... <br /> subdivisionSeepage Trench .......... <br /> Camping Unit .......... .................................................... Privy <br /> 12 <br /> .. ..... .. ....................................... Seepage Bed Q <br /> S FT <br /> _________________________________________________________________ ___ .N <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched In Fig. A- Inclu e road �p <br /> setback, side and backyard dirnenslon and location and setback from all bodies of water If properly S located at a hiphwi y inter <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EX STING <br /> 0 <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o <br /> 5. Lot Size: Fig. A. 6. Location: a <br /> ................ ft. x .............. ft. — ............................... sq.ft. ................................................................... ........... <br /> kZ <br /> SEE ATTACHED SHEET = <br /> N o <br /> o <br /> N <br /> o <br /> o <br /> I s <br /> a <br /> T <br /> z o <br /> 0 <br /> p <br /> y7 V r a' 0 Z <br /> nQ < �_ c m <br /> N N W <br /> 7. <br /> O.Ge < ro E. R <br /> Z <br /> O > n m <br /> X C) — <br /> -0 pit <br /> APRIL 29,1987 0 <br /> �. .�.y/7/...........,7/..J.L ..................................... ...................................... o C <br /> Signature of 9�daac.er <br /> Agent <br /> Dater — <br /> x z <br /> Remarks ................................................................................................................................................................ ........ T rr <br /> C <br /> to <br /> ............................................................................................................................................................................... ........ — . : . : : : <br /> It <br /> ............................................................................................................................. ........... .. ................ ........ 1�� <br /> Z rr <br /> Inspection Date ....................................... ITIQ L...l.. :....7�.Q . . . �V N rr <br /> . .......... . Y <br /> Zoning Admirat ' <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involvingsanitai feollltics <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolatioi test must be attached to <br /> this application before a permit will be issued. Do not purchase or install a septic tank, do any pl tmbing or start any build- <br /> ing until a permit has been issued. A permit may be revoked If misrepresentation of any of the ir formation conveyed her(- <br /> with <br /> erewith is found to exist. Changes in plans or specifications shall not be made without approval of he Zoning Adm inistiatm . <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />