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Burnett County Office of Zoning Administrator �' o <br /> APPLICATION FOR SANITARY - LAND USE - BUILDING PERMIT 3 0 <br /> o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and �1 <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the �$ £ <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and <br /> regulations of the State of Wisconsin. <br /> John..K3P.P................................................................... . .......................................................................................... G A <br /> OWNER(please print) CONTRACTOR or SURVEYOR or AGENT '� V o <br /> Box 4 4rD <br /> ................`J.......................................................................... ADDRESS <br /> m :4 <br /> ADDRESS <br /> North,•Branch.r..MN......55056 <br /> :o <br /> . tT <br /> .............................. . .......................................................................................... <br /> : t <br /> :o <br /> ADDRESS ADDRESS <br /> ....-.-.................................................................................. . .......................................................................................... I :o <br /> PHONE PHONE <br /> ' ................................................................... <br /> PLUMBER WELL DRILLER v ` <br /> ....Bax..W.......S.irs.n.,...W1.....54.87?............................... . ....................................................................I...... <br /> ............... :V <br /> ADDRESS ADDRESS 0 p <br /> .....7.15.,.34.9...5364........................................................... . . . . .................................................................................... <br /> PHONE PHONE o r; <br /> DESCRIPTION 4. Sanitary Facilities: 0 <br /> No. Bathrooms <br /> 1. Work: 2. New Building Details <br /> �••• 'o <br /> No. a <br /> New Building ..... Type Of Construction: Sep Bedrooms ......• ^— $ <br /> tic Tank Size Gals. 7.5.0•••. <br /> Pj <br /> Addition Sep <br /> Size .............. ft. x ft. .......... s i <br /> Sanitary ....%�.... ..... ........ <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> SoilType .................................... <br /> Moving .......... Area ........................................... o i <br /> Slope .......................................... � <br /> Mobile Home .......... <br /> Perc. Rate ........................3......... w <br /> Privy .......... 3. Use (describe exactly,�t -family 0 m <br /> Well home,garage,motel, etc.) Dry Well ••.•.....• Z <br /> Seepage Trench .......... o rr <br /> Subdivision .......... .................................................... Privy .......... (�) c> <br /> Camping Unit .......... .................................................... Seepage Bed <br /> .X....... scn <br /> t <br /> -------------------------------------------------- <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. <br /> c <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is located at N �. <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. <br /> ----------------------- w E <br /> Fig. A. 6. Location: i <br /> 5. Lot Size: 9� :t m <br /> ................ ft. x .............. ft. — ............................... sq.ft. a - <br /> cl w � <br /> N O <br /> O <br /> See Attached <br /> 0 <br /> 0 <br /> �: 0* <br /> iu <br /> Z <br /> 0 <br /> � d <br /> N � <br /> _ m <br /> � v <br /> � N-" nCN C C d C <br /> „a� ' nm _ <br /> M <br /> m <br /> naS <br /> OH O •� D i <br /> O N d MI <br /> o o RI <br /> m <br /> A ' <br /> Si nature of Owner or Agent Date � o <br /> Remarks <br /> N <br /> ..................................................... : O <br /> .......................................)�a <br /> �n....................................... a O : N 'n <br /> Inspection Date ....................................... .. . . .......:1-C�: .. �J.�)................. c rtl <br /> Zoning Ad , ni ator d" ' g $ y <br /> NOTE: A preliminary site inspection must be made and site apprgranted onall 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 application 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 APPROVED. <br />