1984/08/27 - SANITARY - SAN - New Non-Press - 11583

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Burnett Cbunty Office of Zoning Administratorv 0 0 APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT. 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 m c Ordinance, Sanitation Cod , and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. a ........... U..l..!�....... �.....� �!`.. �F�...... f ....... ........ _ o Q OWNER (please print) CONTRACTOR or VEYOR or AGENT a ��....1��................................. ........- ....................... ADD ESS - - ADDRESS r...c.r...j..�.....f........... ............................................................ ADDRESS ADDRESS PHONE PHONE ..................................................................................... q PLUMB WELL DRILLER 'J :� ..�.....�r7.�.�.........�.�.� ................ ADDRESS ADDRESS ;�CD < 0 0 .......... ................. .......... o PHONE PHONE Z y r DESCRIPTION 4. Sanitary Facilities: / ° o ° 1. Work:2. New Building Details No. Bathrooms ( M y o New Building „•„••,,. Type of Construction: No. Bedrooms z �yCD Addition••• •••• Septic Tank Size Gals.'� rSize ............ ft. x .............. ft. • .......... Sanitary Filling/Grading,/ Height ............. Stories ............... 4a. Absorption Field Site: Moving .......... Area Soil Type ...........� �c..trS..G j; o ........................................... Mobile Home.......... Slope .............. L"".. ........ Priv Perc. Rate ............. Privy .......... 3. Use (describe exactly, 1 -family ........................ •••••••• Well .......... home, garage, motel, etc.) Dry Well .......... (� Subdivision ......,,,• Seepage Trench .......... n .................................................... Camping Unit Privy P 9 ..................................... Seepage Bed 601 r Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. Include road \ a setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- _ section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. ` o' ------------ ---- ------------------------ J 5. Lot Size: Fig. A. 6. Location: ................ ft. x .............. ft. — �%�.<.. .. sq. ft............................................................................... 0 O O XO T CD Z 0 m CD n Cn r -V CD N Q. C Q. W d U1 < y K Z C:, CD D a m O as 0 ............... ..... .:.� 2.,dr.............: ;... �'"3 U o c Signature er or et Date — : : : : . . Remarks........Z.(f..... ... 'G?2`'__.................................................................................................................... -nXCD 0 CD ......................................... ............... ............................ Inspection Date ...`:......��. -7/f ...... � �............ o o ('I m m Zoning Admi istrator K J o 0 0 0 o N VOTE: A preliminary site inspection must be made and site approval granted on all structures involviirlsanitary facities )efore construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to :his application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build - ng until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- Nith is found to exist. Changes in plans or specifications shall not be made without approval of the Zoning Administrator. SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED.