1986/08/21 - LAND USE - SUB - Subdivision

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ON COMPUTER/SCANNED Burnett County Office of Zoning Administrator 0 0 APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT '– 3 o ) 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 La d U58 m C v\�, OrdinanceSanitation Code, and with all other applicable County Ordinances and The laws and regulations of the State of Wisconsin. 3 cc i (� ... ..... ................ .. . _ OWNER (please print) COPdT�RACTOR or SURVEYOR or AGENT a .. ....................................................................................... ADDRESS ADD ,........1.......:.....1� ............... ......... U . ADDRESS ADDRESS ........................................................................................... .................................................................................. ......... PHONE PHONE `\ ........................................................................................... .................................................................................. ......... PLUMBER WELL DRI LLER ........................................................................................... ADDRESS ADDRESS m L7 n O ........................................................................................... .................................................................................. ......... O .i PHONE Z N ' DESCRIPTION 4. Sanitary Facilities: ° or ° 1. Work: No. Bathrooms v 2. New Building Details •..•...... o New Building .......... Type of Construction: No. Bedrooms .......... u Addition .................................................... Septic Tank Size Gals. .......... ...... SanitarySize ft. x ft. PillingtGrading ......,,,, Height............. Stories ............... 4a. Absorption Field Site: Moving Soil Type .......................... .......... .......................................... ........ rMobile Home Slope .......................................... o 0 Priv Perc. Rate ................................... Privy .......... 3. Use (describe exactly, 1 -family Well , ,,, ,.,, home,garage, motel, etc.) Dry Well '• SubdivisionSeepage Trench .......... Camping Unit .......... .............................I...................... Privy ._ .......................................I............ Seepage Bed `— Location of proposed structures and exisliing structures, well, sewage systems, roads, etc_ should be sketched in Fig. A. Inclu e road � setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highwa inter- section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXITING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o_ _---__.__--_________------------------------------------------------ --- 5. Lot Size: Fig. A. 6. Location: "--_ ................ ft. x .............. ft. . ............................... sq. ft. .................................................................... .......... 11 j panes _ o 4%_, as z �- f.. I p < ,< D a m Z oo n X .0on `. �'-Ord rd ........... ::..a. :: ... p Signature of Owner or Agent Date O C X � Remarks .................................................................................................................................................................. ...... m m m 4_ O ................................................................................................................................................................................. ...... . : : : : : . . . . . ...........................................................................................................................................................................,.. .... i ddsgi T m { Inspection Date ....................................... ...........��/f lZoning Ad /n sttra (i ' 4 C I 0 0 0 fh 0 0 M i5trat0 r, �) � ic(j g o 0 0 0 o fn NOTE: A preliminary site inspection must be made and site approval granted on all structures it volving sanitary facilities before construction can begin. In the case of sewerage disposal systems, a copy of the percolallon test must be attached to this application before a permit will be Issued. Do riot purchase or install a septic tank, do any plumbing or start any build- ing until a permit has been issued. A permit may be revoked if misrepresentation of any of the In orrnotlon conveyed here- with is found to exist. Changes in plans or specifications shall not be made without approval of tie Zoning Administrator. SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED.