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Burnett County Office of Zoning Administrator
<br /> APPLICATION FOR SANITARY - LAND USE - BUILDING PERMIT m Al 3
<br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and '2 M
<br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the n J
<br /> Burnett County Ordinance, Sanitation Code, and with
<br /> County Ordinances and the laws and
<br /> regulations of Stateof
<br /> Wisconsin.
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<br /> OWNERseCONTRACTOR or SURVEYOR or AGENT 3 0
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<br /> 8108 Needham ave NE.,••.,••,......... P. 0 B0:{ 1 cx1
<br /> .................. .... 01..............7........................... .................................
<br /> ADDRESS ADDRESS �--/
<br /> L1, RIV _i, I.ZN 55330 FER
<br /> SPOON , 'JI 54801
<br /> ..................... ...... . .......................... ....................................................
<br /> ADDRESS ADDRESS .� 1J
<br /> 7.15•-635...7595..................................................... �C
<br /> PHONE PHONE
<br /> ALYN- J. Hr LM ................................................................. �J
<br /> PLUMBER WELL DRILLER
<br /> SPOONER, 11 54801 0 �j
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<br /> ADDRESS ADDRESS n O
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<br /> ........NE.................................................................................... o
<br /> PHONE PHO '
<br /> DESCRIPTION 4. Sanitary Facilities: ° o 1
<br /> 1. Work: No. Bathrooms
<br /> 2. New Building Details """"" ;�
<br /> XX No. Bedrooms 2... °
<br /> New Building .......... Type of No. �j R .
<br /> Addition ,,,,,,,• • VOOD Septic Tank Size Gals. 'x..5.0. :�-
<br /> ................... ............ ..............
<br /> Sanitary ....,U Size ........24. ft. x ...2.4..... ft. ..........
<br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site:
<br /> Moving ...I...... Area ........................................... Soil Type ..........SAND............... `• -
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<br /> Mobile Home .......... Slope ................... o
<br /> .Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ........................ ..........
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<br /> Well Dry Well .......... ,'� i
<br /> ,......... home,garage,motel, etc.)
<br /> subtlrolaion ,,,,,,,,,, 1—FAIJIILY HOIaZ Seepage Trench .......... o
<br /> .................................. .................
<br /> Camping Unit Privy ..........
<br /> .......... ............................................... ....
<br /> Seepage Bed --
<br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A.
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<br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is located at �
<br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersection. (.fi ;% ' E
<br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. t o
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<br /> 5. Lot Size: Fig. A. 6. Location:
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<br /> ................ ft. x .............. ft. — ............................... sq. ft.
<br /> SEE ATTACHED SIEET C ✓ 0
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<br /> igor Agent Date
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<br /> Remarks
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<br /> ........................................................................................................?oval
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<br /> Inspection Date . ....v ,,�' ................. N M N J J N
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<br /> Zonin Admini ator 8 8 8 88 8 m
<br /> NOTE: A preliminary site inspection must be made and site appranted on all structures involving sanitary facilities before construction
<br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this application before a permit will
<br /> be issued. Do not purchase or install a septic tank,do any plumbing or start any building until a permit has been issued. A permit may be
<br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or specifications shall not be
<br /> made without approval of the Zoning Administrator.
<br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED.
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