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Burnett County Office of Zoning Administrator �' c <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 p E-7 <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the ,� c <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws nd <br /> regulations of the Stateof Wisconsin. a N <br /> . •x <br /> .....Bob..Mar.�°................................................................ ...................................................................................... . ... 4 n ; <br /> OWNER(please print) CONTRACTOR or SURVEYOR or AGENT 3 <br /> 1866•.Merrill..ST.,................................................. . ...... E-S- ...................................................................... ...... 'a <br /> ADDRESS ADDRESS <br /> Roseville.,•..Mn.....551. .1] qm <br /> ADDRESS . ...... .... . .. ........................................ .AODRESS.................................................................. ... !J :.Y•� 3 <br /> (J) '0i <br /> .....6..12.-.20.-5.1?5.......................................................... ..................................................................................... ...... <br /> PHONE PHONE <br /> o <br /> A.an ]d...Da.aa..els..................................................... ..................................................................................... ...... ,^ <br /> PLUMBER WELL DRILLER is <br /> .......................................................................... <br /> ADDRESS ADDRESS o <br /> Siren.....W:L-5.48.T.2..........349.-55.33.................... ..................................................................................... ...... Z H E <br /> PHONE PHONE r <br /> DESCRIPTION 4. Sanitary Facilities: °_ o <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details ...... c ' <br /> New Building .......... Type of Construction: No. Bedrooms ... �... : `• <br /> Addition Septic Tank Size GaU�......... .................................................... t06 <br /> .. <br /> .� <br /> J . <br /> Sanitary .... Size .............. ft. x .............. ft. <br /> ., n <br /> �.••• 4a. Absorption Field Site: <br /> Filling/Grading ,,,, H <br /> ,,,,, eight............. Stories ............... ; <br /> Moving .......... Area Soil Type ............................. ...... : : r i <br /> MobileHomeSlope ................................... ...... .. <br /> ...... ... <br /> Privy .......... 3. Use (describe exactly,'1 -family Perc. Rate ............................ ...... <br /> Dry Well <br /> Well home,garage, motel, etc.) .•• •••'•• T <br /> - <br /> Seepage Trench z <br /> Camps ' <br /> Bion .......... .......... o <br /> Camping Unit Privy ....... .. i <br /> Seepage Bed .. ....... <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fl . A. _ <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. It property is local d at <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersect on. <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o <br /> --------------------------------- ---- — <br /> ------------------------ - - '1 J t» <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. - ............................... sq.ft. ....................................................................... ....... <br /> vt <br /> N O <br /> O J <br /> O _ <br /> e IN <br /> O <br /> 0 <br /> 0 <br /> Z <br /> a <br /> :\nIw11 W <br /> / T <br /> O <br /> D <br /> J <br /> b <br /> O � <br /> M c M. w m 0 cm ca a V <br /> n v.a < J J n - - In <br /> m moo.�c � o. m nny <br /> D ' <br /> OOJ Nn 9 <br /> /o c m <br /> m � <br /> o : D <br /> ............... ............. .............. ........................... ............... x o <br /> Signature of Owner or Agent Date 1 [ g <br /> Remarks ...................... . ......... .... n ' <br /> w N <br /> ..... ..... .... <br /> Inspection Date .Y.2a /....- � �' .. . .... .77�... ...:.....��` ..... .. . .... ' ' � o o' � m <br /> Zoning Administrator 8 8 8 8 S 8 m <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 appl cation 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 bee issued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or pecifications 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 />