1986/08/21 - LAND USE - SUB - Subdivision

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Burnett County Office of Zoning Administrator fT o 0 APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 0 , TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as N :6 '- shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m Or pante, Sanitation Code, and with all other applicable County Ordinances and the laws aid regulations of the State of Wiscpnsin. 3 a v H .... ......................................................... . ....... . . ... ........ .......................................... n OWNER (pl ase print) CONTRACTOR or SURVEYOR or AGENT I o. A ADDRESS ADDRESS F ................. .........I........ o ADDRESS ADDRESS ' r ........................................................................................... ...................................................._.............................4........ PHONE PHONE ........................................................................................... . . . ............................................................................ ........ PLUMBER WELL DRILLER . . .................................................................................. . ..................................................................... O i ADDRESS ADDRESS ti o . . . . . . .................................................................... ................................................................................... ........ : J' PHONE PHONE Z N DESCRIPTION 4. Sanitary Facilities: ° o o ' 1. Work: 2. New BuildingDetails No. Bathrooms ~`` .I........ ox/v i New BuildingT No. Bedrooms a YPe of Construction: n Addition .......... ...........................I........................ Septic Tank Size Gals. ........ Sanitary .......... Size .............. ft. x .............. ft. . ........ Filling/Grading .,.,,..,,, Height............. Stories ............... 4a. Absorption Field Site: i Moving .......... Area Soil Type ........................... ........ r Mobile Home Slope .......................................... 0 .......... Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... well .......... home,garage, motel, etc.) Dry Well .......... i SubdivisionSeepage Trench .......... .......... ................................I......I............ Camping Unit „ ,,,,,,,, Privy .......... .................................................... Seepage Bed .......... Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A- Includ road setback, side and back yard dimension and location and setback from all bodies of water- If property is located at a highwa inter _�- section, show the intersecting highways and the setbacks required along them and at the intersection- CLEARLY LABEL EXI TING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. p' _----_---_----------------------------______--------_—_____-----___-- c 5. Lot Size: Fig. A. 6. Location: ................ ft. x .............. ft. . ............................... sq. ft. .....................................................................I......... �.�yPv\i A �s rte, Yoh. z o 4 Irl M * N to Z � a U .am TV ° m z C) na77 0 3/ n m 3 m _ < Is Signature of Owner or Agent Date c X M Remarks ......................................................................................................................................................................... T my m ................................................................................................... Cie ..... .... ...... ..... . ........ ...... .... .. . ... ...... ...... ..... ..... ... ... ............................................. ..... . . .... Ul Inspection Date .......... ...... l..L) -v.....1... - :.: id. . u rn o P” o u' ... . ...... ..... . Zoning Admmrstratbr Ffyl ° j° 8 0 0 0 0 o ti 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 plu Bing or start any build- ing until a permit has been issued. A permit may be revoked if misrepresentation of any of the inf rmation conveyed here with is found to exist. Changes in plans or specifications shall not he made without approval of the Zoning Adm inistratol . SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED.