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Burnett County Office of Zoning Administrator I; o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3• <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and 0' <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations nhe t12 of Wisconsin, a !l'lUl <br /> .... .................................... ......... .. \ � 1..tw.......................................... R _ <br /> OWN R lDleese pri t) I CON7,9ACT98 or SURVEYOR or AGENT ° <br /> ..1kg ..Rd.............................. ......RJ �...,..>.. .. Q........... <br /> .... <br /> ..... <br /> ............................... d Y- <br /> AD FESS AD SS m <br /> JARK.a.,..M1 ...., �.................... ... 1......�`�.sq . ............................. <br /> ADDRESS ADDRESS <br /> ..................................................................................... <br /> PHONE PHONE <br /> .. . ...... ............................................................................... W. .EL. ..L...D.R...ILL.....ER....................................................................... <br /> PLUMBER <br /> O <br /> ........................................................... .ADDRES.. .. .. ... .. .. .............................................................................. _. 3 <br /> ADDRESS S n O <br /> ................................................. 0 <br /> < <br /> ............... . . .................................................................... ........................................... O n' <br /> PHONE •••� � � PHONE Z <br /> DESCRIPTION 4. Sanitary Facilities: P o ° <br /> 1. Work: 2. New Building Details No. Bathrooms <br /> """"" i o i <br /> New Bulldinp „ ,,,,,,,, Type of Construction: No. Bedrooms .......... R <br /> Addition .................................................... Septic Tank Size Gals. .......... i < <br /> Sanitary .......... Size .............. ft. x .............. ft. <br /> .......... <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... AreaSoil TYPE .................................... o <br /> ......................................... <br /> Mobile HomeSlope .......................................... .. <br /> .......... <br /> Privy .......... 3. Use (describe exactly, 1 •family Perc. Rate ................................... <br /> wen .. ... ... home,garage, motel,etc.) Dry Well .......... _ <br /> Seepage Trench o <br /> Subdivision ”"""" ' <br /> Camping Unit Privy .......... <br /> .......... .................................................... <br /> Seepage Bed <br /> ........ <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is located at _ <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersection. r N <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> ____________________ _____ .� li <br /> 5. Lot Size: Fig. A. 6. Location: <br /> C3: <br /> ................ ft. x .............. ft. — ............................... sq.ft. ............................................................................ . <br /> tF <br /> 1 <br /> e fc0' <br /> N C' O <br /> yov <br /> 0 <br /> 0 <br /> F <br /> /- z — <br /> 0 <br /> 9 <br /> v <br /> e <br /> m <br /> N c m m o c c <br /> n o_ JJ (J - - m <br /> O < I d C y J J 3 <br /> y G O m b <br /> Z O > <br /> Na ' <br /> on 0 <br /> c C <br /> n : m <br /> ........................................................................... ...................................... <br /> Signature of Owner or Agent Date : g <br /> Remarks � � n <br /> m •• <br /> ........................................................................................................................................................................................ o : o <br /> 0 <br /> 0 0 <br /> .................................................................................................... N N N N <br /> TmInspection Date ....................................... Zoning Admin.str. r <br /> 8 0 8 8 8 $ rn <br /> NOTE: A preliminary site inspection must be made and site approal 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 />