1986/12/12 - LAND USE - SUB - Subdivision - 12842

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Burnett County Office of Zoning Administrator d o 0 APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 TO TH= ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as '� ~ o shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m C Ordinance, Sanitation Code, and with all other applicable Count Ordinances and the laws and gulations of the State of Wisconsin. 3 to PP Y ... . ..................... ................ ...1` .ic<h.� .1....s�: �z�r ............................. N a OWNER (please print) CONTRACTOR or SURVEYOR or AGENT m m ........................... r,.... .................... d s>v i ADDRESSADDRESS ........................................................................................... ' ADDRESS ............................................................................................ ADDRESS � ( PHONE................................................................................ .PHON.E........... ..... ....... ..... .................................................... � \ innn\\ �J . PLUMBER ............................................................................. .............. .� WELL DRILLER ........................................................................................... . ......"'E'S.............................................................................. : n ADDRESS ADDR ,ESS m u7 n o PHONE PHONE 0 ' r DESCRIPTION 4. Sanitary Facilities: ° o ° 1. Work: 2. New Building Details No. Bathrooms o New Building .......... TYpe of Construction: No. Bedrooms .......... z addition .......... ..........................I......................... Septic Tank Size Gals. .......... �-� Sanitary .......... Size .............. ft. x .............. ft. .......... Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: Moving Soil Type ..................... ............. .......... ........................................... ' : r 0 Mobile Home .......... $OPe .......................................... Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... -v.,l '• Well ...... home,garage, motel, etc.) Dry Well .......... Subdivision Seepage Trench .......... Camping Unit .......... .................................................... Privy .......... Seepage Bed .......... ;moi E E -------------------------------------------------------------- Location of proposed structures and existing structures well, sewage systems, roads, etc., should be sketched in FIg. A. Include road f I setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- O- section, show the intersecting highways and the setbacks required along them and at the intersection_ CLEARLY LABEL EXISTING Y•) vl a STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. '\ o� ---------------------------------------------------------------------- i 5. Lot Size: Fig. A. 6. Location: ................ ft. x .............. ft. . ............................... sq. ft. .............................................................................., 0 o sola � I s �LIq-is O Z - z o � v an Q < ^ c m m a a < = m n m 0 o n o o � m ......................of O..................................................... ...................................... :moo C_ Signature Owner or Agent Date �» X Remarks ......................................................................................................................................................................... m m e» .........................................................................................I.............2te ................ . .......g ........................................... . . . . I CS • T Inspection Date ....................................... : : o o m !�/ m Zonin Admin' rotor o 0 0 o rnNOTE: A preliminary site inspection must be made and 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 build- 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 be made without approval of the Zoning Adm inistratol . SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED.