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Burnett Coyr'yOffice of Zoning Administrator C o Z <br /> o <br /> APPLICATION FOR SANITARY — LAND USE,.— BUILDING PERMIT <br /> 3 <br /> TO THE 4-ONING ADMINISTRATOR: The undersigned hereby makes application'for a Permit for the work described and located as < H <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a ::V) <br /> ;eorge Arthur Vanderport <br /> ....... ........... ...................... . . ... . . ....... ..... . . ........................................................................................ <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT m <br /> 1322 Foster Av. Duluth, I'in. 55811 a — <br /> ..................... ..................................................................... <br /> ADDRESS . .......................................................................................... m �� :✓? <br /> 18- ADDRESS <br /> 722-7303 <br /> .... ........................................................ <br /> ADDRESS ADDRESS <br /> PHONE . . ................................................................................... .� <br /> PHONE...... ' <br /> ........................................................................................... � <br /> PLUMBER WELL DRILLER <br /> ........................................................................................... . ...................................... �j <br /> .................................................... <br /> ADDRESSC7 <br /> ADDRESS <br /> 'm <br /> n 0 o C <br /> _. < T <br /> PHONE <br /> PHONE......... <br /> ............ <br /> .................. ........... <br /> ............................ •" ` <br /> DESCRIPTION 4. SanitaryFacilities: ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms N/A..... <br /> New Building ';;. ...... Type Type of;Construction: No. Bedrooms <br /> Addition •Z(,,,,,, Frail. Septic Tank Size Gals. <br /> Sanitary .......... Size ...1.(b'....... ft. x ..14....... ft. .......... ;`U <br /> Filling ,,,,,•,,,, Heighi..�?......... Stories ............... 4a. Absorption Field Site: :,T- <br /> Moving <br /> r <br /> Moving .......... Area ridG.Yl�1fl..AS�dAt.�Ga...... Soil Type ........................N�A o <br /> NIA..... 0 <br /> Grading ........:: 140 Sq ft. Slope ................................. ........ <br /> Mobile Home Pere. Rate ........................V i <br /> 3. Use (describe exactly, 1 -family <br /> Priv Dr Well N � <br /> Y .......... home,garage, motel, etc.) Y 1....... <br /> WellSeepage Trench N/.A..... 0\ :4 <br /> .......... .h.ak�ktea..additiaa............. <br /> Subdivision .......... Priv NSA..... n ,�. <br /> ........................................... ...... y <br /> --------__ Seepage Bed N/A..... <br /> ----------------------------------------------- r <br /> Location of proposed structures and existing structures,well,sewage systems, roads, etc.,should be sketched in Fig. A. Include road 3� Cr <br /> setback, side and back yard_dimension and location and setback from all bodies of water. If property is located at a highway inter- �. a <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 /> —————————— Ci•O a <br /> ---------------------------------------------------------- E <br /> 5. Lot Size: <br /> Fig. A. 6. Location: <br /> ...220..... ft.x 6.00....... ft. -132OW.................. sq.ft. Se.RA...17.....Twn....41.2g...15............................... <br /> r;=e <br /> 0 n 'C)nri <br /> p <br /> ' , ' ? <br /> jI <br /> o Ci <br /> wis : <br /> Z <br /> yr <br /> C W <br /> < =IF m <br /> ` I o p ? m <br /> :. �...�..:..� Y t •Z••/�/9f3............ ' Dg ature &Owner or Agent ... ..... <br /> °. i ; C <br /> / x ` 77 <br /> Remarks m <br /> ....:................................:i.................................................................................................................... <br /> :. II <br /> ........................................................................................................................................,..... ! <br /> ......... ............................ i T <br /> Inspection Date ....................................... •v.✓ ;1 a/, >.� �._ �,,,i o 0 0 0 o on m <br /> ............ .............. ............................ 000000m <br /> ZoningAdminisirator o 0 0 0 0 o rn <br /> NOTE: A preliminary site inspection must be made and she 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 be made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />