1988/05/26 - LAND USE - SUB - Subdivision (3)

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Burnett Cogaty Office of Zoning Administri itor �' o APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT m 3• TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and '2 yz 0 O located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements o the n t Burnett Count Land Use Ordinance, Sanitation Code, and with all other applicable Count Ordinances and the laws and 3 . regulationsof the State of Wisconsir `••,,f �. r-�.�.I• .. a .' ^ (...d..�l.. �1.. �.Sll....k1.1.17�..... .. e P h ......yr)1 4.r1 ........................ ...... \ R..--(please prm CONTRAC###OR or SU RIVEYOR or AGENT 1..`.�.r.... .. ..... .. ............... Gv.S.. 1. / . .1. ................ ....... a r't,� Ir, I ` -�,�I ...................... ........ ...5. �yr�. . .l. i...1.4.rkJ�/V. d 'y' A. R V. ....�J.VEL.......w-::.,. ........................ ADD .L1l.:C.4 7...p...Y�'..fr:...1.....�: .1............. ....... iJ ADD ESS ADDRE � pj ........................................................................................... .PHO*'H.0.N..E........................................................................... ....... S/ PHONE .. . ...... ............................................................................... ........L D.....R..IL.... ......................................................... �� ...... ....... PLUMBER WELLE.. R ' o f3 .......................................... ....... _. ADDRESS ADDRESS � C . ................................................................................... .P..HO..N..E.. ........................................................................... ....... O .: PHONE 9 N 0 DESCRIPTION 4. Sanitary Facilities: o e o 1. Work: No. Bathrooms I 2. New Building Details " """' i o i New Building T No. Bedrooms E o .......... Type of Construction: . """' E Addition .................................................... Septic Tank Size Gals. .. ....... .......... Sanitary Size .............. ft. x .............. ft. .. ....... FIIlingr Grading .......... Height............. Stories ............... 4a. Absorption Field Site: Moving .......... AreaSoil Type ........................... ....... .. i o i ........................................... Slope .......................................... MODIIe Home .......... .. Privy .......... 3. Use (describe exactly,'1 -family Perc. Rate .......................... ........ Well home,garage, motel,etc.) Dry Well ..... Subdivision Seepage Trench .... \ ...................................................: Camping Unit """"' Privy i ' Seepage Bed ..... ---------------------------------------------------------------------- Location of proposed structures and existing structures well sewage systems, roads, etc., should be sketched in Fig. A. g Include road setback,side and backyard dimension and location and setback from all bodies of water. If property is loca ed at �� a highway intersection, show the intersecting highways and the setbacks required along them and at the intersec ion. t`i'CV-1 i `- CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. �? 0 ---------------------------------------------------------- -- 5. Lot Size: Fig. A. 6. Location: t .J ................ ft. x .............. ft. - sq. ft. ........ n C S Orn, o VUI e o 0 330 T t Dc Z z o Mtnvm r- Dmm '0 M c . w d 0 c c _ m m Nn�c � am nn � (O f0 N rn n A Sm � o O c C x A : m ........................................................................... ...................................... V y . Signature of Owner or Agent Date �Cy,.Je $ T J N Remarks n m •� ................................................................................................................................................................................. ...... ......................................................................................................... ... ....................... . ...... o . .................... o Inspection Date .. .. . .,., �Q,r. �, .our° N o o m Zoning Administ tor�.zJT)....... • _ S S S S S S rn NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities before construction 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 be issued. Do not purchase or install a septic tank,do any plumbing or start any building until a permit has be n issued. A permit may be revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans oi specifications shall not be made without approval of the Zoning Administrator, SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE ANDA PROVED.