1984/08/27 - SANITARY - SAN - Repl Non-Press - 11588

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?L G' Burnett County# Office of Zoning Administrator g) . o O 1 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 v o shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Usem c ' Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 .... '�..k; . •`.. ..- O ................................................................................... ............................. OWNH EEEa m 0 /R('p11edase print) CONTRACTOR or SURVEYOR or AGENT o •.. ..... ADDRESS ADDRESS ADDRESS . '...........4r�(.%.,T..��F...................................................................................................... ADDRESS ........... ... jc. ......... .. .......................................................................................................... , PHONE f / PHONE HCl...Q.......��f?G1.... ✓,J'' .............. ...... ............................................................................. PLUMBE WELL DRILLER ` !•••• ......... .f...�i l .�!i ....... ti�1 0 ............ — ADDRESS ADDRESS < C _. PHONE PHONE i DESCRIPTION 4. Sanitary Facilities: ° o o f 1. Work: No. Bathrooms.... 'U1 2. New Building Details o New Building Type of Construction: No. Bedrooms:�? AdditionSeptic Tank Size Gals. �� ................................................. 'SanitarySize ft. x ft. "•" "" • Filling/Grading Height ............. Stories ............... 4a. Absorption Field Site - Moving i .......... Area : � .o Moving Soil Type ..........% : Mobile Home Slope ............ :.................. 3 \ Privy .......... 3. Use (describe exactly, 1 - family Perc. Rate .............................. Well home, garage, motel, etc.) Dry Well .......... F SubdivisionSeepage Trench .......... .................................................... Camping Unit .......... �, .................................................... Seep age Bed ,l fp2p -------------------------------------- -----= _----------- �6� u, 1 ! C/)Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. Include road C: setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- u a section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING s < STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. ---------------------------------------------------------------------- t f J 7 5. Lot Size: Fig. A. 6. Location: � ................ ft. x .............. ft. — ............................... sq. ft................................................................................ \ o C na N V o. o :\ 0 4a N N) W -n r: L: Ca Z W O r CID Cn r v m, W z CD d2 CID CID �Qa•< =_.a a cNn <. y : � S � W IV H O . (D M Z 00 a �7 . _ a _j h M ...... .............. o ; :... . Signatu f Owner or gent Date Remarks (.(/(1 ..yam .................................................................................................................................... T : . . . . m CD : ................................................................. — : ................................... �:�r�.��......'........................................................ .....................,,............................. II Inspection Date ...... g-0 /!i✓ � ... ................... t o o o m ............................................. /. i coo oom Zoning Admirtfstrator o 0 0 o o N DOTE: 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 riot 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 be made without approval of the Zoning Administrator. SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED.