1987/04/15 - LAND USE - LUP - Other - 12950

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Em Burnett County Office of Zoning Administrator d - o 0 3 APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 TO THE 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 Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 Joan Trulsen ( & Wm ) — �1 I'e'a' ....................................................................... ............................................................................................ :G OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a �^- 2064...Randol.P.h...A`!.e......................................... .AD......D.RESS.................................................................................... ADDRESS St . Paul , i.......55.. ....1 .05.. U ..................................... . . . .................................... ............................................................................................ I ADDRESS ADDRESS (j 61.2-699-40671 ........................................................................ ..........E.................................................................................. _ PHONE PHON 'J > .......... PLUMBER WELL DRI LLER i� .................................................. O ADDRESS _ _........................................................................ ZiDDRE SS : m < io1 n O o n PHONE PHO0 ;�NE 3 Z 0 DESCRIPTION 4. Sanitary Facilities: ° o ° 1. Work: No. Bathrooms 2. New Building Details ' o New Building Ty e of Construction: No. Bedrooms .......... z m Addition r„ Septic Tank Size Gals. .......... .....x... .... ..0.. C ................................... .� Sanitary .......... Size .....1.�..... ft. x ......2.0... ft. .......... Filling/Grading ..... Height....8....... Stories ....1.......... 4a. Absorption Field Site: 9 .....I........ Soil Type ............................. ...... Moving .......... Area ............... .. . ...... . Mobile Home . . $IOPe ......................................... .» .......... PrivyPere. Rate ................................... .......... 3. Use (describe exactly, 1 -family Well .......... home,grage,.r�otel, etc.) Dry Well ......... Subdivision 1 am 1 1 y Seepage Trench .......... `hl .................................................... Camping UnitPrivy .......... .......... ..............................I..................... Seepage Y- Bed .......... -------------- r to Location of proposed structures and existing structures, well, sewage systems, roads, etc-, should be sketched in Fig. A. Include road setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highevay inter- Aj,' 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. V\ o' ` ---------------------------------------------------------------__--___— y� 5. Lot Size: Fig. A. 6. Location: ................ ft. x .............. ft. . ............................... s ft. U1 q. ............................................................................... : Township of Swiss History 13-22 S13/T41 /R15 Acres 18. 000 o 0 PCL# 41 . 15 . 13 . 04200 W1 /2 NW SE Ex N 100 ' & PCL o €"j,) Fa a LLI f1 LG I';L e- o 3 I t't Drr XiG�,A-k z :Z O ,13� f °"`► a sit I �� \I O M (n r T .N to 2 _ c m V - -. N d d N 4 tp O NGC I m c Z ca o D a m o a l/ ct5 � / J �o ... .. . . ..................:en-............................... � — � 47 A,Sid wfY�r �ies5w� ...................................... --II-- _ Signatur Owner or Agent Date S S/BNy, "/f; - . C X 7C1 Remarks .... — ' nd 1 _ ' . u Inspection Date ....................................... ..��.... ..... .....:GU/ '/� N ro WN m .................. (� uuov vm Zoning Ad istrator S S S S �S N NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary tacilitins before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test most 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 lie made without approval of the Zoning Administratol . SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED.