2009/08/10 - SANITARY - SAN - New Mound <24"

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�-«1�y' Baty Office of Zoning Administrator W 0 0 APPLICKNON FOR SANITARY`— LAND USE — BUILDING PERMIT - 3 m C) �1e ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as < N �` shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a r N .......... ................. .......................................................................... c OWNER (pl ase ntl Ck Mf CONTRACTOR or SURVEYOR or AGENT a m �s .- a w ...... ................................................................ ............................................................................................ v ADDRESS ADDRESS m ........................................................................................... .... .................................................................................. :^ ADDRESS ADDRESS ........................................................ :Y_) PHPE PHONE Id aP ;,r, ........................... . .......................................................................................... PLUMBER WELL DRILLER O Al ....................................................................... ............................................................................................ _. ADDRESS ADDRESS 0 0 .� ........................................................................................... ............................................................................................ o ,r' :ellPHONE PHONE Z H r IS DESCRIPTION 4. Sanitary Facilities: ° o ° : `f Bathrooms r 1. Work: 2. New Building Details No. """"" Bedrooms .......... New Building ,,,,,,,,,, Type of Construction: No. v IJ\ Addition .................................................... Septic Tank Size Gals. ._....... < .......... - Sanitary ...X.... Size ft. X ft. """"" •4- Filling l Grading .......... Height............. Stories ............... 4a. Absorption Field Site: SoilType .................................... r Moving .......... Area ........................................... Soo Mobile Home .......... Slope .......................................... Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... Well home, aro e, motel, etc.) Dry Well .......... i Subdivision , „ g g Seepage Trench .......... Camping Unit .......... .................................................... Privy .......... Seepage Bed .......... -------------------------------- Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched In Fig. A. Include road or setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- '( a section, show the Intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING '- < STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. r U.I o _____________________ _ __ _ 5. Lot Size: Fig. A. 6. Location: � 1 ................ ft. x .............. ft. . ..................._ ..... sq.ft. .............................................................................. ; to v s 8N O O 7 —V O LU _ O I i � s T Q O C 7a on i— �yi m 2 O N Q m a ¢ W 6 m _. m o �^. y n Z oO ¢ � 31 En _o � •R _� L1ilg m %-, L .... r,,r .......................... ....:.................. . . .......... ::. o CSig tore ofcm Agent Date "k){ X — m m Remarks ......................................................................................................................................................................... m bo ........................................................................................................................................................................................ — n as M Y Inspection Date ....................................... .... ...�...../.. ................ z `i U o 0 0 0 o m c�;"` ......Zoni g Administrator E�_ �. $ o 0 0 0 o N NOTE: A preliminary site inspection must be made and site approval granter) 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, d0 any plumbing or start any Lend- ing until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- with is found to exist. Changes in plans or specifications shall not he made without approval of the Zoning Adrninistratol . SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. 101. iia