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Burnett County Office of Zoning Administrator 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3 o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < 7 :V <br /> u <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 <br /> //the lawssj and regulations of the State of Wisconsin. n a» <br /> . ''�' "r ../ ?�p4'.'.✓.�?.7.C���Z'rt.r .:°L . ...C�/.-...'..!..`...y.'.'fP' ............................................ m o <br /> OWNER (please rintl� CONTRACTOR or$' R WVOR or AGENT <br /> . <br /> n <br /> }V <br /> ........................................................................................... i..l.'r1.Lt.. ...... �C�.. >r.'..LG/......................................... <br /> ADDRESS............................................................................ ADDRESS <br /> �t....L F 1 !LJ/ S yG .F�. :�. <br /> Y ... ...«.....%............................... . .............. <br /> ADDRESS ADDRESS ip's. <br /> ,1 i <br /> ........................................................................................... .P..HONE................................... ... <br /> .. ................................................. <br /> PHONE <br /> ................................................................. i Vs i <br /> PLUMBER WELL DRILLER <br /> .......... <br /> .. . . .................................................................................. AD . . ...................................................................... <br /> ADDRESS DRESS <br /> < !........................................................................................... . . . . .......................................... ....................................... .: iR <br /> PHONE PHONE Z r <br /> DESCRIPTION 4. Sanitary <br /> Facilities: ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms .......... o Sll� <br /> New Building .......... Type of Construction: No. Bedrooms .......... <br /> Addition Septic Tank Size Gals. .......... <br /> Sanitary .......... Size .............. ft. x .............. ft. .......... Y <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area . ......... ...... Soil Type .................................... o <br /> Mobile Home Slope <br /> .......................................... <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Well ,,,,,,,,,, home,garage, motel, etc.) Dry Well .......... � <br /> Subdivision .......... Seepage Seepage Trench .......... <br /> .................................................... <br /> Camping Unit .......... Privy .......... <br /> .................................................... Seepage Bed <br /> ------------------------------------------------ N <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. Include road <br /> Q <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- a <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING <br /> A <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. p' <br /> ------------------------ ------------ <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. . ............................... s9.ft. ............................................................................... i <br /> 0 <br /> N o <br /> o <br /> i � F <br /> m <br /> VAS Z <br /> 0 <br /> d <br /> M Z <br /> to <br /> PQ � m � <br /> � m m <br /> o �.I y s <br /> z o o a 331 <br /> o <br /> in - <br /> � 0 77 <br /> ...................................... . . .. ...................................... .,U m C <br /> Signature of Owner or Agent Date <br /> X <br /> Remarks ......................................................................................................................................................................... m mm <br /> M <br /> ........................................................................................................................................................................................ .i <br /> ......................................................................................................... .................................. ......... ........................... <br /> , H <br /> U, <br /> T <br /> Inspection Date ....................................... .GZzr.,.u:z.�..�..:'.`.:aa.��..�g�yacJ..N.�................ <br /> . oNONa � m <br /> Zoning AdmYistrator 8 8 8 8 8 80 <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 be issued. Do not purchase or install a septic tank, do any plumbing 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 Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />