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Wis. rid. el-7 Iz-4?7�-f <br /> A County Office of Zoning Administrator 0 rT o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT a 3. _ y <br /> o <br /> THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as � N <br /> .own herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m C <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> Arthur & Leonard Johnson o <br /> ...................................................................... ............................................................................................ <br /> OWNER (please print) CONTRACTOR or SU RVEVOR or AGENT o. 0 <br /> Rt . 2 <br /> ADDRESS............................................................................ .ADDRESS............................................................................ <br /> m n' <br /> Siren , WI '3 <br /> ADDRESS....... .................................................................... . .................................................................. <br /> ADDRESS .......... :G <br /> 3 <br /> `\ <br /> 349-5041 <br /> PHONE PHONE � :•,� r <br /> Donald Daniels ?� .� ; to <br /> ........................................................................................... ............................................................................................ i .0 <br /> PLUMBER WELL DRILLER � : � ;� <br /> Siren , WI 54872 � o <br /> ........................................................................... ............................................................................................ _. <br /> ADDRESS ADDRESS '�� � o 'CY <br /> 715-x+63-2333 �- <br /> ........................................................................................... ............................................................................................ o <br /> PHONE PHONE Z :a <br /> DESCRIPTION 4. Sanitary Facilities: 2 ^ ° ° :m <br /> 1. Work: 2. New Building Details No. Bathrooms .......... o ?o <br /> New Building .......... Type of Construction: No. Bedrooms ...3..... <br /> Septic Tank Size Gals. 1 000 <br /> Sanitary .....7L.. Size .............. ft. x .............. ft. <br /> FillinglGradingg 4a. Absorption Field Site: <br /> .......... Height............. Stories ............... <br /> Moving .......... Area Soil Type .................................... o <br /> Mobile Home Slope .......................................... .» <br /> Pe�. Rate ................................... b <br /> Privy .......... 3. Use (describe exactly, 1 -family <br /> Well .......... home,garage, motel, etc.) Dr Well .......... � E,y <br /> .......... <br /> Seepage renc <br /> """""Subdivision .......... <br /> .................................................... Priv <br /> Camping Unit .................................................... Seepage <br /> ' <br /> ' <br /> Bed mound •• <br /> ---------------------------------------------------------------------- <br /> Location of proposed structures and existing structures, well, sewage systems, roads etc., should be sketched in Fig A. Include road I ^ p Q <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 (A <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. Z. I <br /> ------------------------------------------------------------ -------- w <br /> o <br /> 5. Lot Size: Fig. A. 6. Location: 0 <br /> `3 0 <br /> i <br /> ................ ft. x .............. ft. — ............................... sq. ft. ............................................................................... �. <br /> e• ot, <br /> 7 W � <br /> G <br /> N <br /> o �h3 o <br /> o <br /> Oil <br /> O <br /> CI' � <br /> 1 ^3 <br /> o <br /> v N � <br /> SEE STATE APPROVED PLANS <br /> Z kip <br /> 0 <br /> m <br /> m <br /> m c r T m cm m <br /> n EACs < m R_ F <br /> •c — <br /> �. <br /> C. w m <br /> m <br /> �Ca <br /> Fin <br /> JI <br /> ...:................ ........... ................ ................. ... o <br /> SigAof Owner or Agent ' Date <br /> X <br /> m <br /> Remarks ......................................................................................................................................................................... Fin <br /> A p <br /> m <br /> ............................................................................................................ ................ . ..... ............................... <br /> ( — $ � r, , m � Nm <br /> Inspection Date ....................................... ... . ............. .. - %I............................. o u, o u, o u' m <br /> ZoningAdmin' rotor 8 8 8 8 8 8 N <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 /> - <br /> ng until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here <br /> - <br /> ith 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 />