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Burnett.County ' Office of Zoning Administrator 1c i <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 613 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and ~ 0 t�- <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the c tilJl'v' <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 ii r' <br /> reu Ions of the State of Wisconsin. <br /> t r ... ..i e .r.,e u ..fg �� >" ft <br /> ea.l.. 1................/�� <br /> NER (elegise rind CONTRACTOR or SURVFVOR or AGENT r $ <br /> 1��r. ........�.4...:...J` D59............ .............. ............................................................................. d <br /> 3�7 <br /> ADD"SS <br /> ..lJ..7.... .....15K.......................................... ADDRESS <br /> i ( <br /> ADDRESS ADDRESS 7 <br /> ........................................................................................... ............................................................................................ 1 l" <br /> PHO LLrr ................................................... PHONE .9 <br /> . .!1a�?...f1.r.n..r i <br /> PLUMBER WE LL DRI LLER � <br /> ' / 1 � I 'o <br /> ....DRESS i�.i....Y.0 L .... J`���� ................. ............................................................................................ <br /> ADDRESSo <br /> ADDRESS � <br /> 0 � <br /> ....6141.....................--....................................................... .-H-0-..................................................................................... o 'r <br /> PHONE PHONE Z N <br /> 'r <br /> - <br /> DESCRIPTION 4. Sanitary Facilities: P o ° Cd <br /> 1. Work: 2. New Building Details No. Bathrooms a <br /> ... i <br /> New Building T No. Bedrooms <br /> g .... <br /> Type Construction: ""•••••• <br /> h ; <br /> Addition .......... ........ ....n.9..!1'f>. ..... 26 <br /> Septic Tank Size Gals. 7...5... •4 <br /> Sanitary ..}... Size ...QP..... ft. x ...�.�.... ft. .... ..... <br /> Pilling/Grading g 4a. Absorption Field Site: ` E <br /> .......... Height............. Stories ............... i <br /> Moving .......... Area ..5.C.Z.N �.c7:iS.�l......�.x•t�' Soil Type .................................... r f <br /> Mobile Home .. .. Slope .......................................... <br /> Privy 3. Use (describe exactly -1 -fam' Perc. Rate ................................... R" <br /> Dry Well <br /> Well •......... home,garage,mote , etc. "•"""• Z <br /> Subdivision •� Seepage Trench .......... ' 'W <br /> .......... ...........� .. 1. . ..................... <br /> Camping Unit Privy <br /> ----------------------------------------------- Seepage Bed----------- i E <br /> y <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. c - <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is located at Ln <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersection. IUV <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o <br /> - Lot Size:--------------------------Fig. - 6. Location------------------------ <br /> ................ ft. x .............. ft. - ............................... sq.ft. ............................................................................... :� N <br /> 0 <br /> iP <br /> NGW OW 1 fDA0 <br /> g7 <br /> Carl �JOhanneS <br /> Dfz <br /> f <br /> Grove, <br /> T <br /> y SG2,c��c h P <br /> d <br /> aa' <br /> a=WW0aCM <br /> o Hcr < o -' -' m <br /> m �n�c � nm aa >0 <br /> 9 Sm dmomm �' <br /> Z <br /> -0 m .Z D 1 <br /> o Nom . yn ' <br /> n ; � <br /> o c' m <br /> 0 0 <br /> ................................. ...................................... <br /> c_ <br /> s <br /> M <br /> ignature of Owne r Agent Date <br /> S ; <br /> Ti m <br /> Remarks ......................................................................................................................................................................... 0 <br /> N <br /> o ; g <br /> .......................................................................................................... ...... ...........I.... . ............... <br /> 0 <br /> ............................... <br /> Inspection Date f ro m <br /> ....................................... . . ................. .. N �Noocn m <br /> ........ ...................................... <br /> Zoning min istrator <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 />