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Burnett County Office of Zoning Administrator ly M a 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 '� H 0 t�;� <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use iVJ <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 <br /> ti a :H 0 <br /> Paul Connolly a <br /> ............................................................ ............................................................................................ <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT o. tD <br /> Route 5, Box 115B t <br /> . . . ..................................................................... . . ...... . ............................................................................... a it <br /> ADDRESS ADDRESS x� ;CD ;-o <br /> Hudson, WI 54016 :a <br /> . . ...... . . ............................................................................... [ <br /> ADDRESS ADDRESS9� <br /> .� <br /> '. :in <br /> ........................................................................................... . . . . ................................................................................... <br /> PHONE PHONE <br /> Bruce Plorriski <br /> ............................................................................ . ....... <br /> PLUMBER WELL DRILLE..R................................................................... <br /> „Luck,,,. WI o <br /> ...................................................................... . .......................................................................................... <br /> ADDRESS.... . :�, m <br /> ADDRESS M <br /> ZGt.35........................................................... ............................................................................................ o �. <br /> PHONE PHONE Z H <br /> DESCRIPTIONo 0 <br /> 4. Sanitary Facilities: o <br /> 1. Work: 2. New Building Details No. Bathrooms <br /> New BuildingNo. Bedrooms .. ...... <br /> .......... Type of Construction: <br /> Addltlon ........., .................................................... Septic Tank Size Gals. ......... <br /> Sanitary .......... Size .............. ft. x .............. ft. 2-1000gal Holding T>janks <br /> Filling/Grading 4a. Absorption Field Site: w ' '• <br /> .......... Height............. Stones ............... <br /> Moving .......... Area Soil Type .................................... i <br /> ........................................... r- <br /> o <br /> Mobile Home .......... Slope .......................................... .. <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... w <br /> t <br /> Well ,,,,,,,,,: home,garage, motel, etc.) Dry Well <br /> Subdivision ,,,,,,,,, Seepage Trench .......... M <br /> .................................................... <br /> Camping Unit .......... Privy .......... ' <br /> .................................................... Seepage Bed ......... <br /> ----___----_ _ ------------------------------------- J V1 <br /> Location of proposed structures and existing structures,well,sewage systems, roads,etc., should be sketched in Fig. A. Include road e 'LO <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS.---------------------------------------------------------------------- <br /> 5 <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. . ............................... sq.ft. ............................................................................... <br /> See Attached e <br /> N O <br /> O � <br /> J <br /> ao N <br /> O ~ <br /> 0 <br /> I � <br /> a <br /> T iy.d [ W <br /> <p Z <br /> Z <br /> o <br /> m <br /> m <br /> 6] <br /> : E <br /> N r rn eT Z <br /> m �c n c m <br /> O INTI d C '< c <br /> m <br /> Z O o D a m <br /> o � . nam 31 <br /> Signature of Owner or Agent Date ° <br /> X <br /> Remarks ......................................................................................................................................................................... T m <br /> v <br /> ........................................................................................................................................................................................ <br /> II . . . . <br /> N . Njm <br /> Inspection Date ....................................... .�2?.'G.4i.....1......... ?t... ....> ...... i i ,(''il <br /> � . m <br /> Zonin Admin' tS rator t 88 18 8 8 to <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 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 tie made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />