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Burnett,County Office of Zoning Administrator g 0 0 <br /> P.PPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3. <br /> 0 <br /> TO THo-ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as H t, <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 N <br /> a to O <br /> Frank Pressellero f <br /> .................................................... <br /> OWNER (please print) CDNTRACTOR or SURVEYOR or AGENT a a o <br /> 3651 Van Buren St. N.E. <br /> .......... <br /> ..... ..................................................................................... .................................................................................. n <br /> ADDRESS ADDRESS <br /> Minneapolis, MN. 55418 <br /> .... ...................................................................... ............................................................................................ <br /> ADDRESS ADDRESS <br /> ........... <br /> PHONE................................................................................ .PHONE..................................................................... y, � :(D <br /> Donald Daniels -� <br /> ........................................................................................... . . . ..................................................................................... <br /> PLUMBER WELL DRILLER pig F, <br /> Box Wt Siren, WI 5!+.872 <br /> . . ................................ ...........................................................................I................ <br /> ADDRESS ADDRESS m O <br /> n O <br /> 715.4i......................................................... ^. <br /> PHONE PHONE Z <br /> r <br /> DESCRIPTION 4, Sanitary Facilities: ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms • •'•• o 1— <br /> New <br /> New Building No. Bedrooms "O <br /> .,,,...... Type of Construction: �••��'"�• :— �o <br /> Septic Tank Size Gals. .......... <br /> Addition .......... .................................................... Sep < <br /> sanitary ,....X. - Size .............. ft. x .............. ft. Holding Tank "'X""' <br /> Filling/Grading ..... .... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area ........................................... Soil Type .................................... r <br /> o <br /> Mobile Home .......... Slope .......................................... 0 <br /> Privy ,,........ 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Well .......... home,garage, motel, etc.) Dry Well .......... <br /> Subdivision Seepage Trench .......... <br /> .......... ........................ ........................... <br /> Camping Unit Privy .......... <br /> .......... .................................................... Seepage Bed <br /> .......... :0 <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig, A- Include road ;l, <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property 7s located at a highway inter- V a <br /> section, show the Intersecting highways and the setbacks required along them and at the Intersection. CLEARLY LABEL EXISTING k = <br /> 0 <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. - o' <br /> ____ <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. . ............................... sq.ft. ............................................................................... siJ i i <br /> i o <br /> n <br /> N o <br /> 0 <br /> 0 <br /> V: S <br /> z <br /> 0 <br /> 3 � <br /> r <br /> 0 <br /> cn :r <br /> 00 :rn <br /> S <br /> M N ci m to <br /> Z <br /> C N c N <br /> .o (NTt Cm Z <br /> n rr <br /> Z O O n S <br /> O O n p <br /> FA <br /> IT <br /> ........................................................................... ...................................... �0 <br /> Signature of Owner or Agent Date C <br /> , / - x <br /> .0z <br /> Remarks . %nl( X _ `"E�.V � rr <br /> ......................................................................................................... .. .... .. ......... ..._. . <br /> ''// pp . .. ,g�....................F <br /> Inspection Date ..7.-.�. ��.-./'..7 .............. N N o rr <br /> ....... . .. ....... k J <br /> Zonin Admin s rator,��M goo o o r/ <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 lie issued. Do not purchase or install a septic tank, do any plum 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 Adm inistratol . <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />