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Burnett County Office of Zoning Administrator 00 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3. o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as H <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a i <br /> Tom Drews a <br /> ...... ................................................................................... . . "C'* ........................................................................ <br /> m <br /> a E <br /> . . . ...... . . . . <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a Sa <br /> 4026 NE 6th St. i <br /> a <br /> ADDRESS............................................................................ .ADDRESS............................................................................ � 1 iD :O <br /> Columbia Heights, MN 55421 :a <br /> ... .............................................................. ........................... <br /> ADDRESS ADDRESS :d <br /> 612-788-888241 1 ' <br /> ..... ......... ......... ..... ...................................... ...... ........ .............................. :� E <br /> PHONE PHONE <br /> Donald Daniels <br /> ....................................................................... <br /> PLUMBER WELL DRILLER '�. <br /> Box W Siren, WI 54872 ............... o <br /> ............................................................................ <br /> ADDRESS ADDRESS id\ o 0 <br /> 715-463-2333 <br /> . . ................................................................ . . . . ................................................................................... o <br /> PHONE PHONE Z r <br /> DESCRIPTION 4. Sanitary Facilities: ° o 0 <br /> Kone); v <br /> 1. Work: No. Bathrooms ..... J <br /> 2. New Building Details 2"' <br /> New Building .......... Type of Construction: No. Bedrooms .......... <br /> Addition .......... .................................................... <br /> Septic Tank Size Gals. 7��.... :k4 :V <br /> Sanitary ....d6... Size .............. ft. x .............. ft. .......... <br /> Pilling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving Area Soil Type .........................x. <br /> .x..$..x.. <br /> 0 <br /> Mobile Home Slope ............................ ............. i <br /> 0 <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ...........................3...... Fi N <br /> i <br /> Well .......... home,garage, motel, etc.) Dry Well .......... n o <br /> Subdivision .................................................... Seepage Trench .......... IZ <br /> v.: <br /> Camping Unit """"" w ' <br /> .................................................... Privy <br /> .......... Seepage Bed ..>E...... < ci <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. Include road Gtr W <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter ka o. <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o 'A� <br /> --------------------------------------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: •C <br /> ................ ft. x .............. ft. — ............................... sq. ft. ............................................................................... o <br /> Nad <br /> n <br /> nn <br /> u <br /> 0 3�o <br /> o s: <br /> e <br /> c� <br /> s <br /> - <br /> N <br /> Z <br /> O <br /> I M <br /> 1 j <br /> m <br /> :E <br /> 3J N C- MZ <br /> a E <br /> y - <br /> No <br /> "fJ tNP <. c: m m <br /> ffi m <br /> Z <br /> 0j : nm � <br /> m <br /> Ag,aturallldftwiner or Agent Date <br /> X <br /> Remarks ...................................................................................................................... m m <br /> m <br /> ................................................................................................................................t.:r..................................................... (�•• ' <br /> ....................................................................................................... .. .................... r...................................... '1 .li , . . . . . <br /> T <br /> m <br /> Inspection Date ....................................... ..1...... ...................... m <br /> Zoning Adm nistrator <br /> 8 8 8 8 8 m <br /> NOTE: A preliminary site inspection must tie made and site approval granted on all structures involving sanitary facilities <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> this application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build- <br /> ing until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> with is found to exist. Changes in plans or specifications shall not he made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />