2008/07/31 - LAND USE - LUP - Other (3)

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Burnett County Office of Zoning Administrator o 0 APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 0 TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as < N � shown hereiin. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use � C OWNERI' I`,��ion Code, and with all applicable County Ordinances and the laws and regulations of the State of Wisconsin_ 3 a Ordinance, San /, ^ 9 ..... .. JAHi �..... .... ....... ..... ................................................ ........................................... c O print) CONTRACTOR or SURVEYOR or AGENT �a. .��....... .�t14..�.�.......�:r!.g.,.......................... ............................................................................................ ADDRESS \/r� ADDRESS `_^ . ... :' I� ./(�. .:..... .............f....................... ............................................................................................ ADDRESS ADDRESS + /p l a. ....L .. S?66... `/................. ............................................................................................ PHONE ............ .... . .. PHONE ........................................................ . ..... ...... .... ...........DRI.......L...LE..R..................................................................... PLUMBER WELL O ADDRESS ADDRESS m G) bm o ............... . . .................................................................... ............................................................................................ ,» PHONE PHONE N r DESCRIPTION 4. Sanitary Facilities: o ° 1. Work: No. Bathrooms .......... < , T 2. New Building Details o ir, New Building .......... Type of Construction """"" �'o,~c,� Septic Tank Size Gals. .......... ,� Addition ... ...... :!`CG.'.?:.................................. Sanitary .......... Size .....I z..... ft. x ...1..Y....... ft. .......... . Fill ing l Grading .......... Height...5:....... St ries .....!......... 4a. Absorption Field Site: Moving .......... Area KU SSi�9f:�;ln.:t'.-.... Soil Type .................................... Mobile Home Slope .......................................... .. .......... Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... Well .....I.... home,garage, motel, etc.) Dry Well .......... subdivisionSeepage Trench .......... Camping Unit .......... ...............................I.................... Privy .......... Seepage Bed .......... Location of proposed structures and existing structures, well, sewage systems, roads, etc.,should be sketched In Fig. A. Include road (� Q setback, side and back yard dimension and location and setback from all bodies of water. If property Is located at a highway inter- �. section, show the intersecting highways and the setbacks required along them and at the Intersection. CLEARLY LABEL EXISTING o STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. 1 0 O 5. Lot Size: Fig. A. 6. Location: e ............ ft. x .............. ft. . ..........._.................. sq.ft. ............................................................................... O m n N o o � SP 0 4' Tim 4�ec k9 y I 'lO' Z O ]7 Z C N � o N W 4 C "O Qtr c in 9 0 Signa re of Owner or Agent Date X 31 R arks .........................................� m . . . . . . m m En ........................................................................................................................................................................................ — rS ............................................................................................................. ..L........... m m.............................. Inspection Date ....................................... ... . . .... ...... .. . . .. .. ......................................... 1© P P` o u, m u, � Zoni drain strator : g S o o $ V7 NOTE: A preliminary site Inspection must be made and site approval granted on all structures involving sanitary faCil itios 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 a septic 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 Administratol . SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED.