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Burnett County Office of Zoning Administrator �' e <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 0 <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wisconsin. r: C^ <br /> A. Searles & Son (Craig, Root•,home) >n e^ •o <br /> ......... . . ................................ . .. . . . . . ...................................................... ...... _ i <br /> OWNER IPleax Drintl CONTRACTOR or SURVEYOR or AGENT <br /> :r <br /> ° <br /> Hertel.r..W .r.............`14845........................................ ................................................................ ... <br /> ADDRESS ADDRESS O <br /> . . . ................................................................................ .ADD.. ... ............................................................................... ...... <br /> ADDRESS RESS <br /> .......................................................................... . <br /> ......................................................... ........... I N <br /> PHONE PHONE <br /> PLUMBER WELL DRILLER Cn <br /> O :O <br /> :❑ <br /> ..QA.X..w............................................................................. ............................................................................................ _. <br /> ADDRESS ADDRESS o <br /> Sixsn,...W.i.........548.7.2............................................... ............................................................................................ o 'z <br /> PHONE PHONE Z :W <br /> DESCRIPTION 4. Sanitary Facilities: 0 6 1r; on <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details <br /> Naw Building .,••,•.... Type of Construction: No. Bedrooms " '3""' i i o <br /> Septic Tank Size Gals. i^ <br /> Addition .................................................... 000 :ice < <br /> Sanitary ..XXX. Size .............. ft. x .............. ft. .. ....... 1 i io <br /> Pilling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area ......................................... Soil Type ............................ ....... o ?... <br /> Mobile Home .......... Slope .................................. ....... 0 <br /> Privy Perc. Rate ........................... . <br /> .. .... 3. Use (describe -family ...• U � <br /> Well .......... home,garage,motel, etc.) Dry Well .. ....... m i :w i <br /> Seepage Trench .. Z <br /> Subdivision Seepage <br /> Camping Unit .......... .................................................... Privy ....... <br /> Seepage Bed x•x.. <br /> ------------------------------------------------------------------- -- t <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fi 1. A. C <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is locat d at <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the inlersec ion. <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. t o <br /> ----------------------------------------------------- -- <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — sq.ft. i <br /> m <br /> N O <br /> O <br /> O � <br /> 0 <br /> O <br /> f <br /> t � <br /> S <br /> Su1 <br /> N <br /> Z z <br /> 0 <br /> X1 <br /> m <br /> M c <br /> a m a s ON C <br /> o "a < o o n - - m <br /> m N0. o. m ani <br /> ON m ; <br /> p m <br /> Z 80 ';� D � <br /> vein N a <br /> �o c m <br /> a0 D <br /> , "j, 16, "'4�4 A o <br /> ......................... ... ............................................. ...................................... a . <br /> m <br /> Signature of Owner or Agent Date $ <br /> T; v✓ <br /> Remarks n ' <br /> u <br /> o . g <br /> ........................................................................................................ .... ..................¢¢{{.nnJ .. ...,...,... ............. ....... . ... <br /> Inspection Date ....................................... .... ieQ�..1. :.. �,C,G��I.u� . .. N N N o o m <br /> pe . ....,�........... . m <br /> Zoning Administr r CA <br /> NOTE: A preliminary site inspection must be made and site appr at granted 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 be 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. <br />