1986/10/29 - LAND USE - SUB - Subdivision

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Burnett County Office of Zoning Administ ator a o 0 APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3. 0 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 Lad Use m c Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 0 � ..��.b.r. i� .�. ha l....E•...../ .............................. ......... ° . ........................................... N OWNER (Pease print) CON ACTOR or$lifiVEYO�Rp or AGENT a ............... .... .4- {T.....1L�J. .S..L................................ ......... a ADDRESS ADD ES u7................ . ,.... ..... .. 3....... .... ....... . ADDRESS ADDRESS ........................................................................................... .................................................................................. ......... PHONE PHONE ........................................................................................... .WEL.. ... ...L...DR...I..LLER................................................................. ......... PLUMBER i ADDRESS ADDRESS m C) � o ........................................................................................... .................................................................................. ......... PHONE PHONE Z DESCRIPTION 4. Sanitary Facilities: °or 1. Work: No. Bathrooms 2. New Building Details ..•.•. o _ New Building .......... Type of Construction: No. Bedrooms ......... m i Addition .......... .................................................... Septic Tank Size Gals. ......... ,� Sanitary Size ft. x ft. ..•...... Filling/Grading ,,,,,,,,,, Height............. Stories ............... 4a. Absorption Field Site: i Moving Soil Type ................... .......... ........................................... ........ .......... r Mobile Home .......... Slope .......................... ..... ........ o .+ Priv Pero. Rate ......................... ......... Privy 3. Use (describe exactly, 1 -family Well .. ,.., home,garage, motel, etc.) Dry Well Subdivision ...l�... .................................................... Seepage Trench Camping Unit ,,,,, Privy ......... ' .................................................... Seepage Bed Location of proposed structures and existing structures, well sewage systems, roads etc., should be. sketched in Fig. A- Induce road setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a hlghwa 1 Inter- a� section, show the Intersecting highways and the setbacks required along them and at the Intersection. CLEARLY LABEL EXI TING 7C STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. p'- ---------------------------------- ------------------------------- --- 5. Lot Size: Fig. A. 6. Location: ................ ft. x .............. ft. — ............................... sq.ft. .................................................................... .......... :bC m 0. IN 0 is m y6 l a 11 z 0 DO m an o Dfim Z o i o X00 . 10-a3..gin o Signature of Owner or Agent Date m Remarks ..................................................................................................................... m............................................. ...... � � e II O /7. T Inspection Date ....................................... .... ....... .. .........!.....!. ff!ILfC... U o o m l� v : o000om Zoning Adminis aM for 8 0 0 0 0 0 Vr NOTE: A preliminary site inspection must be made and site approval granted on all structures ii volving sanitary facilities before construction can begin. In the case of sewerage disposal systems, a copy of the percolatior test must be attached to this application before a permit will be issued. Do riot purchase or install a septic tank, do any pit mining or start any build- ing until a permit has been issued. A permit may be revoked If misrepresentation of any of the In ormatlon conveyed here- with is found to exist. Changes in plans or specifications shall not be made without approval oft ie Zoning Administrator. SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED.