1984/08/27 - SANITARY - SAN - Repl HT - 11586

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;z a� 7o t: Burnett County Office of Zoning Administrator d o 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 <, - shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use CD c Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 n. 7 Q :� O a...r�n............................................................................................ c' q. ........ ............�a . .!... 5. ............................ C OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a r..:.:.....��:j./..f� ............��1............................................................................................ ....... ....... ADDRESS ADDRESS :c ................ � ....................................................................................................... A DRESS ADDRESS .................................................................................................................................................................................... PH�PHONE :� llilliJJlJJ! ......................... ..... ��....................................... PLUMBER WELL DRILLER '� N,� �V ..........................................................................ADDRESS ........................................................................... 0 ADDRESS •�ID 0 O p' 4 -4' PHONE PHONE ZN 7- DESCRIPTION 4. Sanitary Facilities: ° 0 ° ' 1. Work: No. Bathrooms v 2. New Building Details :� o New Building Type of Constructi : No. Bedrooms .......... 5J C Addition S Ir Septic Tan Size als. i°C} < .....�,-...<.............. Sanitary ..... Size .............. ft. x .............. ft. Q %r .......... Filling/Grading Height Stories 4a. Absorption Field Site:) ............ ............... .f.::'.Moving Area ........................................... Soil Type ....).. 0 MobileHome Slope .......................................... " Privy ,.,,..,... 3. Use (describe exactly, 1 -family Perc. Rate ................................... r` Well home, garage, motel, etc.) Dry Well .......... SubdivisionSeepage Trench .......... Camping UnitPrivy .......... .................................................... Seepage Bed .......... — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 5 cn7 � Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. Include road C_ setback, side and backinter- section, 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 p < STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. y o' ------------=----------------- ----------- 5. Lot Size: Fig. A. 6. Location: G ft. x .............. ft. — ............................... sq. ft................................................................................ ;•- C ti W CD0 N zt O 7 7 v V H� :3 Z cCD CfV - N WCD CD N.1 Q CL 7a ,< N — f Z Oo D 5 00a ID m p _ a O �.. - 7•- �........... o :: : : : NZ p 1 Signature of O 'e' r- orAgent Date - . . . . . . — Rem0�czrl—...�— '- ........................... :. 41: r t #f /�i i:.....:: ..�.......................... M X ......(..!IC.°-: `... ! .. .......................................................................................................................... Ch: Inspection Date I..:�v.......�..�.... �0 ,/0...../.....��,:;�mis • O o cin o °cn° o cin m M Zoning Z 0 0 0 0 0 0 y VOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities )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- vith is found to exist. Changes in plans or specifications shall not he made without approval of the Zoning Administrator. SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED.