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Burnett County Office of Zoning Administratora Z <br /> 0 o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 , <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as 0 <br /> Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisshown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use <br /> Ordinance, Sanitation consin. 3 `0a '/T( <br /> Richard J. Redfern N o <br /> .................................. Se.l............ . . <br /> OWNER (please print) .......... . . ...................................................... c _ <br /> •• .•• •• • ................................ <br /> • •. • •• . .• CONTRACTOR or SURVEYOR or AGENT <br /> .......3�7...'...$TH .AVE. N.'�1. a <br /> ADDRESS .ADDRESS..............................................................I........................... ' <br /> m y <br /> Kas son.e... .........559?+................................... <br /> ADDRESS ... ........................................................................................ �Q •-�� <br /> ADDRESS ! P <br /> .... .635...-...7828......................................................... ' <br /> PHONE . .......................................................................................... <br /> PHONE <br /> ........................................................................................... . ........... .. :l <br /> PLUMBER . ............................................................................ <br /> WELL DRILLER <br /> ADDRESS ... .............................................................................. m L1 :@ <br /> .......... . <br /> ADDRESS -' <br /> < :Ip. . . . . . .................................................................... . . . . ............................... p' ° <br /> PHONE ..................................................... » r: <br /> PHONE � <br /> S <br /> DESCRIPTION <br /> Z <br /> 4. Sanitary Facilities: ° o o <br /> 1. Work: <br /> 2. New Building Details No. Bathrooms <br /> ..... .... <br /> New Building Type of Construction: No. Bedrooms ° <br /> Addition .................................................... Septic Tank Size Gals. .......... <br /> Sanitary Size ft. x ft. ....... .� <br /> Rillingf Grading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area ...................... Soil Type .................................... <br /> ..................... <br /> Mobile Home o <br /> Privy ........... 3. Use (describe exactly, 1 -family Perc. Rate ................................... `� •' ' <br /> {/I <br /> Well .......... home,garage, motel, etc.) Dry Well .......... <br /> Subdivision Seepage Trench .......... i -glj <br /> .......... .................................................... <br /> _-Camping Unit Privy ... .... 1 <br /> .......... .......... T <br /> ________________________________________ Seepage Bed .......... S� <br /> Location of proposed structures and existing structures,well, sewage systems, roads, etc., should be sketched in Fig. A. Include road __' � ° <br /> section, show the intersecting highways and the setbacks required along them and at the intersect <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- n <br /> it " <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. on. CLEARLY LABEL EXISTING 5 <br /> -----------____________________________________— — <br /> 5. t Sz ---- ------------ <br /> e: � .� °. <br /> L.pO_l ,aOUr Fig. A. 6. Location: <br /> ft. x .............. ft. - ............................... sq. ft. ............................................................................... ' <br /> n P <br /> Center line of two 100 ' lots <br /> N i� r!.l o. <br /> ° <br /> W <br /> Township road - 60, o <br /> to r f <br /> y Privy <br /> 20 slope - 251 <br /> o <br /> 40r 130' to lake W <br /> Well - 561 *� <br /> I a i M vtr vg0 M <br /> { �`� a < m 3 `- F <br /> Fir a <br /> m : <br /> ` m <br /> z o0 0 <br /> �� m <br /> o <br /> 0 <br /> �.. .. <br /> Signature o \ r Age ... ................. [°SET [ o C <br /> �'t ,r 1 Date ,. . <br /> Remarks J„L{/. .... �i... C.edf `.S7D X . . : : . . 70 <br /> , ........... .... ..... ............ .. ..............a........................................................................ m <br /> v <br /> ...................................................................................................................................................................................... <br /> d3 _ <br /> ... .. . ...... <br /> .” <br /> Inspection Date ....................................... .�. a ,((nN N m <br /> 8Y8� 888 <br /> ��l\\IJJJJJJ $ m <br /> Zoning dministrator m <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structuresinvolving sanitary facilities <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> this application before a permit will be issued. Do not purchase or install a septic tank, do any Plumbing or start any build <br /> ing until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> with is found to exist. Changes in plans or specifications shall not be made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />