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Burnett County Office of Zoning Administrator <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <br /> all �. 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and rT M iO�l <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. 3 3 a <br /> NORBERT 'JALLENTINY A.T'T.EA.aTH'.1ORK5 CONST. INC <br /> .......... ....... .............................................. .................................V'.E'...................................................... <br /> OWNER Iplesse print) CONTRACTOR or SURVEYOR or AGENT <br /> STAR RT BOX 303 P. O.BOX 71 1 <br /> ADDRES............................................................................. ............................................................................................ <br /> S ADDRESS <br /> "SPOOMR, ?,'I 54801 SPOONS":i, 31 54801 <br /> ....................................................... .A........ .RESS.. ................................................................................ <br /> ADDRESS DD <br /> 7,15-635 7595 <br /> ........... <br /> PHONE PHONE <br /> AP,LYN J. H 71,ld <br /> .................................................................... 'W"'E...L.L...DRIL.... L...... ..................................................................... <br /> PLUMBER WER.. <br /> P..O,BOX 71, SPOONER?...`1L 4801 <br /> ... .............................. ......... ............................................................................................ A ct <br /> ADDRESS ADDRESS <br /> M d <br /> ........................................................................................... ... ............................* <br /> ...................................................... d r1 11. <br /> PHONE PHON......E Z N r <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° ?'O <br /> 1. Work: 2. New Building Details No. Bathrooms ... c <br /> New BuildingNo. Bedrooms ...�...... ? w <br /> . ........ Type of Construction: :�j <br /> Addition ..,....,,. ,,. Septic Tank Size Gals. .......... <br /> ................................................. <br /> Sanitary ...A1.... Size .............. ft. x .............. ft. .......... <br /> Filling/Grading ,,,,.,,,,, Height............. Stories ............... 4a. Absorption Field vS,iLe;.D N <br /> Moving .......... Area Soil Type .................................... o i <br /> ....................................I.... <br /> Mobile Home .......... Slope .......................................... .. <br /> Privy .......... 3. Use (describeexactly, 1 -family <br /> Perc. Rate ................................... <br /> Well home,garage,motel, etc.) Dry Well .......... m <br /> .......... <br /> Subdivision .,_....... page Trench z i <br /> .................................................... <br /> e <br /> .......... O i <br /> Camping Unit .......... Privy ..X..... <br /> .................................................... <br /> Seepage Bed ? (T <br /> Location of proposed structures and existing structures well sewage systems, roads, etc., should be sketched in Fig. A. _ C I I <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. O <- - <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> ____________________________________ <br /> 5. Lot Size: Fig. A. 6. Location: 7-_. <br /> ........ ft. x .............. ft. - .. sq.ft. ............................................................................... r. <br /> Si?E ATTACHED SIET o <br /> o <br /> Irl(� 0 <br /> � s <br /> Z <br /> 0 <br /> 9 <br /> v <br /> b <br /> T <br /> N C N d AC� Cm <br /> O — -' m <br /> o in o .z y 1 <br /> 0 <br /> 00 0 <br /> ........ ...................................... <br /> _ c <br /> s <br /> Si <br /> fur <br /> e O er or Agent Date <br /> M <br /> Remarks ,. ... ..I... z. ....L_W"::,:...t:::. ....-................................................................................................................... L. <br /> ....................................................................................................... : R! cr, O <br /> ....................................................................................................../... ....................... .. ............ .. .... ........ ....... <br /> ^... <br /> Inspection Date ..1......x..1..1...—.r..Q.... L�. ... .... ......... ..........Yc'>,.L,r//Lh ... ., N m <br /> a'N NN OOfn <br /> / Zoning Administra r vs7 '3g 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 before construction <br /> -an 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 /> 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 /> 9d if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or specifications shall not be <br /> ghout approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />