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Burnett County Office of Zoning Administrator V o Z <br /> APPLICATION FOR SANITARY — LAND USE BUILDING PERMIT <br /> d' 3 3 ff�� <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as _Q.< ,,, 'A <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use —0 c � � <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> Lar B'orkltand H <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT m ' <br /> Rt. 3..Box„178....Webster,..W ,,,,,,,, ........ a E L4 <br /> .................................................................................... a j <br /> ADDRESS 54893 ADDRESS <br /> ................................................................. P........................ . ..... ... ............................................................................ - <br /> ADDRESS AD... DRES.. S.. � :yU <br /> 111X 866:n4 866-x.29.8................... <br /> ........................................................................................ <br /> PHONE PHONE f,JJ ib <br /> PLUMBER WELL DRILLER ' <br /> i <br /> Wta.. !I7........................................................ ............................................................................................ o <br /> ADDRESS ADDRESS <br /> �”. o <br /> i _. c <br /> .................................................................. P...HO.......NE.................................. <br /> ................................. <br /> ....... <br /> .... <br /> .... Z <br /> PHONE <br /> r <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms ' <br /> New Building ,,,,, Type of Construction: No. Bedrooms .... .... 'a <br /> iC�...' Tank Size Gals. .......... <br /> Addition .......... .........Frme............................... �trmiR' . <br /> SanitarySize ....24...... ft. x .28......,.. ft. Holding Tank 2,000 Gals..... E .. <br /> 4a. Absorption Field Site: r, i : <br /> Filling/Grading Height.....I..... Stories ............... ' <br /> .......... \: <br /> Moving Area ..6�2.....sga..ft.............. Soil Type .................................... A�: or 'F <br /> Mobile Home ..... Slope .......................................... <br /> ..... <br /> Pere. Rate ....................... <br /> Priv ............ <br /> y 3. Use (describe exactly, 1 -family <br /> Well .......... home,garage,motel,etc.) Dry Well tL <br /> Subdivision .......... ..... tt.4,ghg.o..... h„.�W..gAr.arage Seepage Trench .......... <br /> Privy ..........Camping Unit 2 .. 0.24................... ' <br /> Seepage Bed .......... 1 . <br /> ---------------------------------------------------------------------- <br /> Location of proposed structures and existing structures,well,sewage systems, roads,etc.,should be sketched in Fig. 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. - H <br /> o' <br /> --------------------------------------------------------- b <br /> 5. Lot Size: Fig. A. 6. Location: <br /> 106..... ft. x .100 ft. — ............................... sq.ft. ............................................................................... <br /> rn <br /> SEE PERMIT # 9914 for further details. ^ n <br /> N L O <br /> o <br /> in � <br /> � N <br /> Z <br /> o <br /> t <br /> rnrromZ <br /> 0 Q < <br /> Nnc�c <br /> — w m <br /> 071 <br /> H 0 <br /> O j a <br /> 0 <br /> Sign ure of ner or gent Date <br /> X 70 <br /> Remarks ........................................................................................................................................................... T M.............. � v <br /> ......................................................................................................... <br /> Inspection DatePPPPPPNm <br /> p :............................. vvv. .......... rn <br /> Zoningg Ad�tor' cJ............... 8 8 S S S S y <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be 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 build- <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 made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />