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Burnett County Office of Zoning Administrator d /0 0
<br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT a 3
<br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as —
<br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use 0 C
<br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin_ 0
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<br /> OWNER (please priin7ti p CONTRACTOR or SURVEYOR or AGENT a m
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<br /> ADDRESS ADDRESS
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<br /> PL'UMIBr�E�,t( +'.( WELL DRILLER
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<br /> DESCRIPTION 4. Sanitary Facilities: o °
<br /> 1. Work: 2. New Building Details No. Bathrooms ... o
<br /> New Building ,,,,,,,,,, Type of Construction: No. Bedrooms .. ...
<br /> Addition Septic Tank Size Gals.
<br /> Sanitary Size ft. x ft. ....
<br /> Fillingt Grading ...,,,,... Height............. Stories ............... 4a. Absorption Field Site: i
<br /> Moving .......... Area ........................... ............... Soil Type ...T. A
<br /> Mobile Home Slope ........!„( ,,,,,,, ,,,,,,, „ ,,,,,,, `
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<br /> Privy .......... 3. Use (describe exa -famil Perc. Rate ..... ....7.-.....!........
<br /> Well home,garage, mote Dry Well .......... {
<br /> Subdivision ........., .................................................... Seepage Trench .......... UJ
<br /> Camping Unit Privy ... . .... j f
<br /> .................................................... Seepage Bed .�.., = �
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<br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc.,should be sketched in Fig A. Include roadCT
<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
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<br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. OC —'
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<br /> 5. L t ize: Fig. A. 6. Location: .)
<br /> . ..Q.. ft. x ..(�. ..... ft. — sq. ft. ...............................................................................
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<br /> ign'ture of Owner or Agent Date
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<br /> Remarks .. .... . .................................................................................................................................................. m p
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<br /> Inspection Date ............/ :-,k7............ % /11 ;..1 )......C., 1 c . 9V. ...
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<br /> Zoning Admi I trator o N
<br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary faciliUcs
<br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test rnust be attached to
<br /> this application before a permit will be issued. Do riot 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 Adm inistratot .
<br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED.
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