2014/02/06 - LAND USE - LUP - Other (3)

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BurcetUCeunty •~ . ""�.i'�'• Office of Zoning Administrator Ln A o o. _ APPLICATION FOR SANITARY — LAND USE = BUILDING PERMIT m 3 NN TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for it Permit for the work described and located as '2 � shown herein. The undersigned agrees that all work shall de done in accordance with the requirements of the Burnett County Land Use n °�'�'• Ordinance, Sanitation Cade,add with an other applicable. County Ordinances and the laws and regulations of the State of Wisconsin. _...... ..._.............. .....-.-....°..-- -...................... ..:.-.................. OW/N�E7fl )fired,print) CONTRACTOR or SURVEYOR an AGENT ..h..F.Q ......�„7. v✓QF,D/lt.f�F................ �Aooness ' � .. ... - o... . �.. _. d ADDRESS Elle ...ljiL✓/...... r�r.� ........._....... ... ......:.:............a............................)__._................... .......... ADDRESS T - ADDRESS - 2� .. ppb......_.........._......._....... ..c..... .. . . . ........._ PHONEf'f�......_Z.Y..R..... PHONE ..�(.r...... . ..... ........................................... PLUMBER............ ........S51.Y..... ..........................[ ....�.L�_..... WELL DRILLER , 1 ,O o ADDRESS ADDRESS ................. ........................................... . ......:.......... ..... .... ........ ................. ...................................... o PHONE - PHONE � N DESCRIPTION 4. Sanitary Facilities: � ' F ' o o 2. New Building Details o 1. Work: No. Bathrooms ...r — r� No. Bedrooms A . • � New Building .......... Type offynstruc[ion: Addition .......... /� !'A '+n„ag, Septic Tank Size Gals. 1...... Sanitary - ._G--� Size ..fG`'I ft r"l-1641 e+� ......."- v r "c 4a. Absorption Field Site: Filling .... ..... Height..... .... for s .........._... _ Moving �— Area }-gyp Soil TVP, ........:......................_._ .......... ......W�./nil..-.............. Grading � ...r � .. - Slope ......:... ................ 0... ; Mobile Home ._....... 3. Use Idescribe ex .y 1 � family Pero Rate .......... .................... LJ _ Privy .......... home,garage,motel, etc.) Dry Well - .......... ^\ Well ............................'....................... Seepage Trench . .... Q ...... t ..... Subdivision Privy ......_.. .......... ................................................ _____ ____________________________________________ Seepage Bed____________ �C y . : Lobation of proposed structures and existing structures,wall,sewage systems, metls,etc.,should ton, s fico in Plc. A. Include mbtl ba `n setback, side and back intersecting imension and beano.. add setback from all m and of wales If coon. C is ABLY ata LEX IS inter- _ I section, show the Inters OPO ED STRUCTURES and the setbacks ADDITIONS atony them and at the Intersection.CLEARLY LABEL EXISTING `C 6 fill STRUCTURES AND PROPOSED U — RES AND ADDITIONS. 5.,Lot Site : • Fig. A. ......._._.... ft. x .............. ft. . ............ ........ sq. ft oo o i l l s I � I �r i ed on , ca _ v /. Sign tuuOwner or Ageni f7ate - of a Op Remarks .�.Guo!:!.'S:c'..J2"17Y......W'!Ys(..*. . ...9.-13."b .:..................:..........................'....................t x ........ ...... w : ................................. .:.........d.................... .........................:................................................ ............... _..........:............... . ............................................................................................................................. Inspection Date ....._................................ . t�C2L..... IG.rJ.........................:.............. o m o m er epee' Zoning Administrator q o ce 0 da 0 NOTE: A preliminery site inspection must lie ...file and site approval granted on all rtrirctgrur involving reoilary Inclbt"'x before construction can begin. In the case of sewerage disposal.systems, a cgpy of,thc'percolatiod test must be attached to this application before'a permit will be issued. Do not purchase or furled a septic tank, ado any plumbint,l or vat t any bIIIId Ing . ..til o permit has boon issued. A permit may be revoked if rnirlepnlse,r;rtdon cf nn, of the inlurmeticn convit,rd herr: with is found to exist. Changes in plans or specifications shall,,, b, diad, without approval•of Ihe'Zieuing Ad dt In is U i,In. SEWER SYSTEM SHALL NOT BE COVERED, UNTIL INSPECTED BY. THIS OFFICE AND APPROVED.