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C41,117C �� <br /> Burnett County Office of Zoning Administrator <br /> o z <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 o <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and to ated as — o <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County L nd Use c <br /> Ordlnf�nce Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin, a <br /> f� 3 a <br /> ..... .. ....................................................... .......... ...ARLYN...J,...HELM 0 <br /> . . <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AG...E.NT.. . ........ <br /> ......4.9..69...0aALAND...A.VN.................................. DP.O.BOX 1 <br /> ADDRESS ................. .......................................... ....... a ::: <br /> Op <br /> lYZ ...JiQ.n......MAY...55.4.28................................... ..............SPOONEZa...!q...1? 801 <br /> ADDRESS .. . . . ..................................... <br /> ADDRESS ° :) <br /> .. ...................................................................................... . <br /> " <br /> ...75.-63..5....7595................................................ <br /> PHONE <br /> PHONE ; <br /> ......ARUN.,J. HELM <br /> PLUMBER <br /> ..................................................................................... <br /> WELL DRILLER I60 <br /> 7 % <br /> AD.. <br /> ADDRESS . ...DRESS.......................................................................... .......... � O <br /> 0 <br /> PHONE <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> 1. Work: <br /> 2. New Building DetailsNo. Bathrooms ••• • : _ <br /> 0 <br /> New Building , Type of Construction: No. Bedrooms .......... <br /> Addition !✓� f 2qv.•. Septic Tank Size Gals. ..7.5.4 <br /> Sanitary <br /> FillingiGrading ...x... Size .... 8 .... .... ft. ....... <br /> ........ Height............. Stories ...... .... 4a. Absorption Field $ite: <br /> `- <br /> Moving .......... Area Soil Type ...........� <br /> ................................. . . ... ............ I......... <br /> 0 <br /> Mobile Home .......... Slope ...............0........... .. .......... ,» <br /> Privy .......... 3. Use (describe exactly, i -family Perc. Rate ..<...3.............. .......... j <br /> Well <br /> ... home,garage, motel, etc.) Dry Well .......... <br /> ....... <br /> Subdivision /_ ;/ Seepage Trench .A <br /> .......... ..............f..977.. Y.................. <br /> Camping Unit .......... .................................... Privy ' <br /> Seepage Bed 4f0 Q i <br /> ----------------- --------------- -------- --- f it t'1 <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched In Fig. A. Include road Q. = .� <br /> setback, side and back yard dimension and location and setback from all bodies of water- If property is located at a highw v inter- �• _a <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING I < <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o' >� <br /> _______________________________________________ <br /> 5. Lot Size: Fig. A. 6. Location: W : �y <br /> ft. x .............. ft. . ............................... sq. ft. .............................................................................. <br /> , :E <br /> so <br /> SEE ATIATCHED SHEET <br /> N <br /> O � � O. <br /> o � <br /> l� sr <br /> s <br /> n Z Q <br /> n o <br /> 0 <br /> t <br /> A <br /> �lrr <br /> JJ N so <br /> 13 on N' C C <br /> Z 00 � <br /> � <br /> c—, m <br /> APRIL 29,1987 , <br /> .............................. ...................................... _ p <br /> Sig atur�//// r or Agent Date !�� ° _: <br /> Renoarks�,/t.. 'p7!'P.1;-;, : M <br /> �N <br /> ................................................................................................................................................................................. <br /> 69 <br /> ................................I............................. . . .......�' 1 II . : . <br /> -7 . ... ......... .. ........... <br /> Inspection Date L....�....J�...' .. ..1�.. Gzr �,"'IZonii.g Adlmin trar � r 8 8 i---- <br /> ON <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures Involving sanitary facilities <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test most be attached to <br /> this application before a permit will be issued. Do not purchase or install a septic tank, do any plu Bing or start any build <br /> ing until a permit has been issued. A permit may be revoked if misrepresentation of any of the inf rmation conveyed here <br /> with is found to exist. Changes in plans or specifications shall not lie made without approval Of if e Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE ND APPROVED. <br />