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V// CLyN�� <br /> Burnett County Office of Zoning Administrator <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT0 3. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and '2 p 0 <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the T c app <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws nd 3 -'- <br /> regulationsof the Stateof Wisconsin. » "' <br /> ROBERT SAPP A.IVI.EARTHWORKS CONT. INC. — d <br /> ............................................................. .6" . . . . . . ............................................. ...... = r <br /> . . . . .... . . .......... ...... . . . <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT ., <br /> ROUTE ;r3 BOX 3265 P. O.BOX 71 <br /> ADDRESS............................................................................ .ADDRESS.................................................................. ... A i <br /> SPOONERf.... °.L.. k801................................. SPOONER, 9I 5.4.8.0.1 ..... O <br /> ... <br /> ADDRESS ADDRESS <br /> 6.35..-8560.......................................................... ........6.35,-7595...................................................... ...... <br /> V <br /> .. <br /> PHONE PHONE :Q i •--S <br /> kaZLYN..J.r....HE.LM ......................... ...... <br /> PLUMBER WELL DRILLER: <br /> SPOONER,, WI 54801................................ <br /> ................... .................................................................................... ...... <br /> ADDRESS ADDRESS n O <br /> ........... . 5.-.7.52. .......................................................... ................................................... ................................ ...... o <br /> PHONE PHONE Z ,�„ r <br /> DESCRIPTION 4. Sanitary <br /> Facilities: ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms ... ...... <br /> Naw Building ,,,X,,, Type of Construction: No. Bedrooms ... ..... <br /> Addition ....................................................OD F . Septic Tank Size Gals. ..00 <br /> ....X.... " < <br /> Sanitary .......... Size .............. ft. x .............. ft. .. i <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: SAND Moving .......... Area Soil Type ............................ ....... o <br /> Mobile Home Slope .................................. ....... » <br /> .......... <br /> Privy 3. Use (describe exactly,-1 --family Perc. Rate ........................... ....... 9 <br /> Well .......... h _f ePr1v111,Zo HbM)i;; Dry Well .... <br /> . ... <br /> Seepage Trench o <br /> Subdivision " """' <br /> Camping Unit .......... . ... ........... ......... ..... ................ Privy 6T S ' <br /> " ' Seepage Bed 5.. <br /> .. ....... <br /> ------------------------------------------------------------------- --- <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fi . A. <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is local ad at 1 _ <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersection. <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. = 0 <br /> ___________________________________________________________________ __ <br /> 5. Lot Size: Fig. A. 6. Location: <br /> , <br /> ................ ft. x .............. ft. . ...........�................... sq.ft. .�E�!1... ..:..9 Se-t <br /> I 3 <br /> _.�. t-" 131..69'-�► I.'P. N o <br /> o 0J <br /> EAt.EmEirr �pAt� ul <br /> p <br /> Bw4 yg� t 1' Z 7 <br /> ? 20V. 16' <br /> IS1e:%1 S, IS' 28 y <br /> fi <br /> f•OIG S.0.FT. ' <br /> V�_ � <br /> 8' ALT. SITE 71 .N -o W r- D m w -0 <br /> m c _. m m o c c <br /> n �a < > > n m <br /> 2890< . m � 05'5 <br /> 11 <br /> o N '< p V7 m <br /> 4— 131.'12'-11P l m <br /> C� � ... ..... ............ <br /> APRIL 15 1988 x p o <br /> ................. ...e........... <br /> Signature of lar or_Agent Date <br /> Remarks .. ::....(.....f.�..�-�.`:'.:Z::�....... <br /> N <br /> ............................. .......................................................................... ... ............. ................................................... ..... <br /> Inspection Date .;.�......:..... ....... ........ d) 2;9 9 9 <br /> Zoning Administrator � $ g g <br /> T <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary fa ilities befor construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this appl cation 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 bee 1 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 AP ROVED. <br />