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Burnett County Office of Zoning Administra or <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 9 3• <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described nd <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of he 7 <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws nd <br /> regulations of the State of Wisconsin. ^' a <br /> H <br /> James H. Quinehan <br /> .......................... ..Ow.ner............................... C o <br /> e ..H. ........................................ <br /> OWNER (please pr..int) CONTRACTOR or SURVEYOR or AGENT <br /> 9706 <br /> Blvd <br /> ADDRESS <br /> :................................................. 'a <br /> .......................... kkD <br /> ............................ ........ . ....... . .. .. ..... m 2 <br /> ADDRESS ADDRESS ,} �,r,f <br /> Coon Raids, MN 55433 <br /> j/vhNr ... <br /> N <br /> ADDRESS ADDRESS / <br /> 612-784-8940 °Z <br /> . ............ io <br /> . . ........................................................ ....................................... . ............ .. ...... ..... <br /> PHONE. . . ..... . PHONE m ` ..��.. ... i 1 <br /> Donald•_Daniels . .................. C. ........................... .... ...... J m <br /> ................... . ................................. ....... . ...................................... <br /> PLUMBER WELL DRILLER 1 �y 5 <br /> l i7 'J <br /> 6.4.X..W................. Siren.r...WT.....5......7..................... ......................1/........ 17.. ..1!`?.... .... ...... o m <br /> ...... . 4 8 2 <br /> ADDRESS ADDRESS In) o <br /> 715-349-5533 ......................VV.... .{)...... ...... ° �. <br /> o' <br /> ................................................... . . . . U f / Z N <br /> PHONE PHONE �/'(� � <br /> DESCRIPTION 4. Sa to y �acll :n 6 V o o <br /> No. Bathrooms 11.... i <br /> 1. Work: 2. New Building Details O o <br /> New Building X No. Bedrooms ... R <br /> ..........Addition Type of Construction: 2.... <br /> frameSeptic Tank Size Gals. ..... iN W i <br /> Sanitary <br /> ,,..X... Size ....1.L.4.... ft. x ...,'1.(T...... ft. Holding tank 2•C 00•• E�}J <br /> Filling/Grading Height............. Stories ............... 4a. Absorption Field Site: : '• <br /> Moving 7 �0 Soil Type ............................. ...... r <br /> .......... Area .......... .. .... 0.................. o <br /> Mobile Home Slope ................................... ...... <br /> Privy .......... Perc. Rate ............................ ...... m `d <br /> 3. Use (describeexactly, i -family <br /> Well Dry Well <br /> ,,..--..., home,garage, motel,etc.) "' """ — K rp <br /> Seepage Trench .... z 8 IU <br /> Camps talon 2. bedroom/ single ......•...• o - <br /> Camping unit .......... ...familY...home....................... Privy 0 o <br /> -- ,tl 30 r---------- Seepage Bed --- -- i <br /> ------- _L W •rn In <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fit . A. :� • <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is local d at � <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersect on. — o - <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. : 1 ot 5 <br /> z <br /> _____________________ _ -----_____-----___--------- <br /> 5. Lot Size: Fig. A. 6. Location: to <br /> ft — <br /> ( ..... .. .... . ...................................... .... .. <br /> L <br /> O IU <br /> I <br /> 0 <br /> 1f1Q ~7� 0 <br /> Z W <br /> 'J 6d�m Madelq ° <br /> yVadkaufi 110r �tlk9� <br /> w <br /> / m c � m m 0 a Cm in <br /> oz� in <br /> 3" I m Un< '- nm na >0 <br /> y J ; <br /> u � � <br /> O C m <br /> n o 0 <br /> Int o <br /> ..... ................................................... .............. .............................. <br /> .... ..... .. p <br /> Signature of Owner or Agent Date ! o <br /> T : N <br /> Remarks . ......'.l-... .-L..��. �.................................................................................................................. ..... <br /> .................................................................................................................................................................................. ..... N O <br /> . .s.................... .. .. <br /> ... ' S <br /> ...................................................................................................... : . n <br /> i. ' roro : : ro <br /> Inspection Date /..................................... ..:1 m <br /> Zonin AWnitr <br /> or 8 8 8 8 8 8 (n <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this app ication before a permit will <br /> be 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 /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or specifications shall not be <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND AF PROVED. <br />