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Burnett County Office of Zoning Administrator --i z <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> d - <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit -or 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 c � <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. m <br /> a m <br /> Ph�.l Knudson N <br /> ... .....eas...................................................................... ......................................I..............I........... <br /> OWNER Ipleasa pant) CONTRACTOR or SU RV EYOH orAGENT 3 m <br /> Rt. 2 Box 259 ro <br /> ........................................................................................... <br /> ADDRESS . .......................................................................................... m x^ 3- <br /> ............................ <br /> .F+ <br /> ADDRESS .. , <br /> Stanchfield,. MN 55080 — :� <br /> . . ...................................................I..... .ADDRESS............................................................................ ,� 'W <br /> ADDRESS <br /> ........................................................................................... . . . . <br /> o x <br /> PHONE <br /> G <br /> PHONE <br /> Donald...Daniel.s..................................................... <br /> \� '� <br /> PLUMBER . .......................................................................................... <br /> WELL DRILLER <br /> ....Siren.,...Wl....5.4$7.2................................................ . ...... . ............................................................................ � o <br /> ADDRESS ADDRESS <br /> m <7 <br /> o <br /> PHONE ............................................................................ <br /> PHONE ............. � o <br /> DESCRIPTION o <br /> 4. Sanitary Facilities: o <br /> 1. Work: 2. New Building Details No. Bathrooms ...2...1 1 2i, <br /> New Building Type of Construction: No. Bedrooms ....2.... C z ' <br /> a <br /> AdditionSeptic Tank Size Gals. .. <br /> G N <br /> Sanitary x Hol�b�� ta�k 1 V <br /> .......... Size .............. ft. x .............. ft. .......... <br /> Filling .......... Height........... Stories ............... 4a. Absorption Aeld Site: <br /> ar <br /> Moving .......... Area <br /> .......... ....................... Soil Type ......................................... ................ <br /> Grading Slope ........................... ........... :p, F. <br /> r <br /> ,. <br /> Mobile Home 3. Use (describe exactly, 1 -family Perc. Rate ................................... p, <br /> Privy ,.,,,,,,., home, garage, motel, etc.) Dry Well ,,..,...,. <br /> N <br /> Well Seepage Trench <br /> Subdivision .................................................... ....... .. <br /> a <br /> .......... Privy <br /> Seepage Bed <br /> -------------------------------------- — <br /> --- <br /> ____ ________ <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc-, should ho sketched in EIg. A. Include road <br /> setback, side and back yard dimension and location and setback from all bodies of water_ If property is located at a highway 'inter- a <br /> section, show the intersecting highways and the setbacks required along them and at the intersection CLEARLY LABEL EXISTING <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> V o <br /> ----------------------------------------------- :Z <br /> 5. Lot Size: --- ------ W <br /> Fig. A. 6. Location: d <br /> ft. x .............. ft. — ............................... s4. ft. ............................................................................ w <br /> s o <br /> G m <br /> n <br /> N — <br /> 0 0. <br /> 3 <br /> � W <br /> O <br /> o <br /> F <br /> S <br /> a <br /> See State Approved Plan P <br /> z <br /> z <br /> 0 <br /> N <br /> 31 <br /> a n < o O rn <br /> z o o' '° m <br /> o = � <br /> va rS <br /> p <br /> a <br /> /O - ay .. <br /> . .... ................Date............... — m <br /> Signature of Owner or ent o <br /> i <br /> Remarks ..G / X <br /> .. v. ... Z��rz _ <br /> X <br /> ........................................................... <br /> . .... . <br /> . m <br /> .. . ................................................................... <br /> :r1....ZCJ......../...1,G fG ...................................................................................... <br /> ...................�''Zz ................G� �rl �i " <br /> Inspection Date ..Z) m <br /> . ...................... <br /> . �.�.�.'��...1... :.......!....�' :Ir: O o o �O O m <br /> Zoning Administrator coo 0 o N <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facihti, <br /> before construction can begin. In the case of seweraye disposal systems, a copy of the percolation test must he 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 bulld- <br /> ing until a permit has been issued. A permit may be revoked if misrepresentation of any of the Information conveyed here <br /> with is found to exist. Changes in plans or specifications shall not be mode without IPPrOval of the Zoning Administratui_ <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED, <br />