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1� <br /> r <br /> Burnett County Office of Zoning Administrator d M - 0 <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 located as <br /> 0 <br /> shown herein. TheAujndersign/esJ agrees that all work shall be done in accordance with thu rrequireenne�nts of the Burnett County Land Use c <br /> Ordinanc <br /> OWNER PPl . .....[inti...... J.lj CONTRACTOR <br /> ,.1 .. 0 .....rl....................................... _ 3 a <br /> Sanitation Jc�e, and with all other a Iieable Count Ordinances and the laws and regular ons of the State of Wisconsin <br /> PP <br /> 9.�/..ease... ..... y.8 . ................ ......... ... . :. �. ...... � o � O� <br /> C C O SURVEYOR o AGENT <br /> . („`.. .... ....1.l..`P,.Y...SZ:.y..e..L........................I. . <br /> . .......................................................................................... d �3 <br /> (ARID FSS ADDRESS <br /> ol..a.S.. ..V. .. /t?.......i 17.N.,...........Xa�......... . .......................................................................................... <br /> ADDRESS ADDRESS <br /> b <br /> ............... ............................................I.............................. ............................................................................................ <br /> PHpnUNE PHONE .� . <br /> q� <br /> .p...K. :n.. '... . ............................ . .... . ............. .. .. ...................... ........ .. . ................ <br /> PLUMBER WELL DRILLER <br /> ADDRL-SS ADDRFSS iii- <br /> . <br /> ............................................................................................ z N <br /> HOE ' <br /> PHONE PN ' <br /> DESCRIPTION r <br /> 4. Sanitary Facilities: ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms .... ..... <br /> o <br /> New Building Type Construction: No. Bedrooms _........ <br /> Addition h Q,wv� :....._._..,__... Septic Tank Size Gals. .......... \srt` <br /> Sanitary ..X,,. Size ft. x ...._........ ft. <br /> .............. J <br /> Filling .......... Height........... Stories ............... 4a. Absorption Field Site: <br /> S: <br /> Moving Soil Type ................ <br /> ....... .................... <br /> o <br /> Grading .......... Slope ........................................ ` . � <br /> i - Pers. Rate ................................... r �- i <br /> Mobile Home .......... 3. Use (describe exactly, - t y ; <br /> Privy ..._..,... home, garage, motel, etc.) Dry Well .......... <br /> Well Seepage Trench .......... iC <br /> Subdivision Privy ` <br /> Seepage BedIf <br /> .T.y /- <br /> Location of proposed ',[ILJ(tures and r x sang structures, ivull sewage systerns roads, etc_, shoud be sketched in Fig. A_ Include road <br /> r <br /> setback, side and ho(k yard dimension and location and setback from all bodies of water. If property Is located at a highway inter- j„ Q <br /> section, show the inters c in;I highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING <br /> 0 <br /> STH UCTU RFS AND PROPOSED STRUCTURES AND ADDITIONS !� o' <br /> ---------_._- ---. -----___..--------_-_-------__-__-------------------------- <- <br /> 5. Lot Size: Fig. A. 6. Location: 'vI <br /> ................ ft. x .............. ft. . ............................... sq. ft <br /> 01, <br /> k ti$ n <br /> N ? ° <br /> R <br /> 7 <br /> 0 <br /> f <br /> T \A } <br /> m �l <br /> O <br /> d <br /> 7 <br /> 1 � <br /> 4 <br /> V <br /> 33 ori m2 <br /> No_ a< - » a <br /> -o to <. Ci p1 O V <br /> Oma. a, . < m m <br /> ffl � <br /> o <br /> �� ... . ... .... ...' . .. . .. ... ... ............ ...... ..� <br /> o m <br /> p <br /> Signature o Owner or Agent Date ° C <br /> X 37 <br /> Remarks ......................................................................................................................................................................... T m0 <br /> m <br /> u <br /> .............................................................................................I........... ............. ...............................I............................. <br /> ea <br /> Inspection Date G 3 J J <br /> ...A................................. � . .. . <br /> ix, T <br /> ........... .... . . ... ..T J.............. O O41, <br /> (Pm <br /> �t�/ t� o0omc'19 T c�/ Zoning Adm nistrator Pi o 0o to <br /> NOTE: A preliminary site inspection must be made anti site approval granted on all structures Involving sanitary far,ihtius <br /> before Construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must he attached to <br /> this application before a permit will be issued. Do not purchase or install a septic tank, do any plumhing or sial t any build- <br /> ing until a permit has been issued. A permit may be revoked it misrepresentation of any of the Information conveyed here- <br /> with is found to exist. Changes in plans or speciti Cat ions shall not be made without approval of the Zoning Administrator , <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPEC FED BY THIS OFFICE AND APPROVED. <br />