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Burnett County Office of Zoning Administrator �' c <br /> APPLICATION FOR SANITARY - LAND USE - BUILDING PERMIT m 3• <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and 'z <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the ,8 <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. n <br /> m <br /> ....LLOYD NEi WC... . . . ............................................ . . . ..................................................................... m i <br /> OWNER Iplasse print) CONTRACTOR or SURVEYOR or AGENT <br /> St. Rt. 4 Box 294A <br /> ............ <br /> .. . ............................................................................... ....... ........................................................................ <br /> ADDRESS ADDRESS i <br /> Danburx, WI 54020E� E <br /> . ........ ...................................................................... . .......................................................................................... 1 <br /> ADDRESS ADDRESS <br /> i 1 iG4 <br /> ........... <br /> .....:.-................................................................................. ."40"...E....................................................................... <br /> PHONE PHON : t <br /> Donald Daniels Do E <br /> .....................................—................................................... . . <br /> PLUMBER WELL DRILLER 4.� i <br /> R?..t?.......Siren�..^T.....55872 ................................................... o <br /> ADDRESS ADDRESS <br /> 7.15-399-5533.......................................................... ». ° <br /> PHONE PHONE Z r <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> 1. Work: No. Bathrooms 1........ 'S� 'a <br /> 2. New Building Details c <br /> New Building .......... Type of Construction: No. Bedrooms 2.....-- p 1 R <br /> Addition .......... ................................................... Septic Tank Size Gals. 75©...... I < <br /> Sanitary Size .............. ft. x .............. ft. .......... <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: p --c <br /> Moans .......... Area ......................................... <br /> Soil Type ...................lSam o <br /> Mobile Home .......... Slope ......................... . .. ........... <br /> Privy Perc. Rate ........................ <br /> .......... <br /> 3. Use (describe exactly, -family Well .......... <br /> • -�' <br /> Well •......... home,garage, mptel,etc.) Dry — f <br /> Subdivision Single family M/H Seepage Trench ....X... o <br /> ................................ i <br /> --Camping Unit— Privy .......... :� 1 <br /> ' „Ci <br /> Seepage Bed .......... � <br /> ---------------------------------------------------- 'Cn <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. <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. .S <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> ---------------------------------- ----------------------------------- ' v <br /> 5. Lot Size: Fig. A. 6. Location: ,-.� 't i (Tl <br /> ................ ft. x .............. ft. — ............................... sq. ft. ............................................................................... :L <br /> n <br /> o <br /> :�. <br /> o <br /> See Attached <br /> 0 <br /> — � Z a <br /> o iC <br /> d <br /> m <br /> m cN N n C3 <br /> ti+ m i3 <br /> m <br /> = o : <br /> Si ature of/Owne <br /> r ror Agent Date : o <br /> Remarks .1.�lfJ ... -.Q`.-j/ j:.`. ......................................................................................................................... m n <br /> o . o <br /> o . o <br /> ...........................................................................................................I.... .. ............. .................... <br /> Inspection Date ...7.-. :-..5.7.......... ........... v o o v T <br /> N O N m <br /> Zoning dministrator <br /> NOTE: A preliminary site inspection must be made and site approval 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 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. <br />