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Burnett County Office of Zoning Administrator iC c <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT m 3• f y <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and 'z <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 3 <br /> regulations of the State of Wisconsin. » ^ <br /> rILBUi`; BLOUGH A.M.EAUH':'IORI{S CONST INC. o E <br /> ............. 3 <br /> OWNER (please printl CONTRACTOR or SURVEYOR or AGENT <br /> 3T i'1 BOX1132 P. O.BOX 71 'a i <br /> ADDRESS....... .................................................................. .ADDRESS .. <br /> ............ .............................................................. <br /> ... <br /> SPOONE:3r `2I 54801 SPOONE3 ....'. L..?x4801................................... <br /> t <br /> ADDRESS ADDRESS <br /> 6d" .-.7.59..5.............................................................. <br /> PHONE PHONE <br /> ARI,YN J. H- LM _ Q j <br /> PLUMBER........GG................................................................... .WELL DRILLER................................................................... {/" <br /> ............................. <br /> ............................................................................................ o <br /> ADDRESS ADDRESS G ' <br /> 0 < <br /> .................................................. <br /> ........................................................................................... ........................ ... <br /> ............... •Z N . <br /> PHONE PHONE <br /> DESCRIPTION 4. Sanitary Facilities: ° o °» <br /> 1. Work: No. Bathrooms . <br /> 2. New Building Details •""•"" c E <br /> 9 <br /> Naw Building Type of Construction: No. Bedrooms ...3••••• �$ <br /> Septic Tank Size Gals. 1Q0.0 i <br /> Addition .......... .................................................... , < <br /> Sanitary 4.�... Size .............. ft. x .............. ft. .......... <br /> ElltingfOrading .......... Height............. Stories ............... 4a. Absorption Field Site: p <br /> Moving .......... Area ........................... ............... <br /> Soil Type ............3AN��............. r <br /> MobileHome Slope .......................................... <br /> .......... <br /> Privy 3. Use (describe exactly,'I -family Perc. Rate ................................... <br /> Wall ,,........ home,garage, motel,etc.) Dry Well .......... m U <br /> Subdivision Seepage Trench .......... o n <br /> .......... .................................................... <br /> Camping Unit .......... Privy <br /> Seepage Bed <br /> ---------------------------------------------------------------------- t <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. : Ck_ <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is located at <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersection. UJ `— <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> -------------------------------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: _ <br /> 1 i <br /> ................ ft. x .............. ft. — ............................... sq.ft. ............................................................................. <br /> :ft <br /> SEE ATTACHED SHEET <br /> N O <br /> o J <br /> O ilV <br /> o 0 <br /> --�--\ �. o <br /> Z <br /> O <br /> > <br /> n H cr < Z 0 o -. _. RI <br /> m Na-< — am an p <br /> N : < p 66 <br /> o <br /> Enn <br /> p D n o : p <br /> ........................ ...........A...-.�G..-.S. (fin o <br /> 'm <br /> Sign ure of wn r Agent Date o <br /> f <br /> Remarks ....:......: ./.:.4:.... Z'... ::Y:.: <br /> .............. :�f.'7:.?.'.....t ..................................... .......................................................................... <br /> ............................................................................................................ .. ................. . ..........................�............... <br /> e da T <br /> Inspection Date ./.. ... .:-..X�.�......... ...5... ... . ,1-..'........ �lzZ.c... <br /> M <br /> pe .. . ...... .......... 888888ai <br /> Zoning Administr for <br /> NOTE: A preliminary site inspection must be made and site approv I granted on all 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 />