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Burnett County Office of Zoning Administrator d 7 - o <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 to ated as <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County L nd Use c 'Y <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wi onsin- ma l <br /> ..4..t/.1.1.11ln.wa........� <br /> O <br /> .......eC�:!:`..4.A..tti.................... . .......................................................................................... H m <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT m <br /> 1./..Z.4..........jCko.J.l...!I.S.d....... ........... ............ ..... . a <br /> ................................................... .......... a <br /> ADEIRESS �^ ADDRESS 'a <br /> (.5....�. ........]r.L.� .. ...... :(� <br /> . ............................................................................... .......... <br /> ADDRESSADDRESS :•J�) . <br /> _ <br /> 7.1.5. ....1 Z..�—...-..5...S7 ............................ _ <br /> ................................................................... ............ .......... <br /> PHONE ) •�J�� <br /> ........................................................................................... P. .G. .A.l�......-t.N u.�.... .././.17'".Qe.it �!1ti.5'��`:• S <br /> PLUMBER WELL Dill <br /> i lLLER •� 1 <br /> ........................................................................................... ......[e,l...C....(0....�..........1.1/.JW.S.f� ...........:M. .......... <br /> ADDRESS ADDRESS C <br /> PHONE.................................... <br /> .......................... ........ . . ... s' <br /> .« <br /> DESCRIPTION 0 <br /> PHONE <br /> Z h y <br /> 4. Sanitary Facilities: o <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details - <br /> New 9uildingType of Construction: No. Bedrooms ....... ;? <br /> Addition .......... .................................................... Septic Tank Size Gals. .......... < <br /> Sanitary Size ft. x ft. ...••.•••• <br /> Pillingf Grading .......•,• Height............. Stories ............... 4a. Absorption Field Site: -r' <br /> Moving .......... Area ........................................... Soil Type ......................... .......... <br /> Mobile HomeSlope L <br /> o <br /> Pr .......... 3. Use (describe exactly, 1 -family Perc. Rate ........................ .......... i <br /> 'ell .......... home,garage, motel, etc.) Dry Well ........ . <br /> ubdrvision .......... Seepage Trench .......... :L <br /> Camping Unit .......... .................................................... Privy .. ....... i1'{ <br /> . ............... Seepage Bed .. ....... 1 <br /> --------------------------------------------------------------- <br /> 2 :N <br /> Location of proposed structures and existing structures, well,sewage systems, roads etc., should be sketched in Fig- A- Inclu e I--,- <br /> .setback, <br /> oadsetback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highwa inter- a <br /> section, show the Intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING 5 <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> ON <br /> o <br /> ___ ________________________ _--____----_ <br /> ___ I 0 <br /> 5. Lot Size: <br /> Fig. <br /> A. 6. Location: (O� , <br /> ........... ft. x .............. ft. - ............................... sq. ft. <br /> ....................-.............................................. .......... N t <br /> t <br /> m <br /> N <br /> j r o. <br /> d <br /> :� <br /> !' o <br /> Max �P A <br /> � � ZA <br /> S � o <br /> M rnr- �, � WZ <br /> o Q = < <br /> va a - t <br /> c: <br /> - a ID <br /> Z ooDam <br /> i . Eim <br /> Q - <br /> Signature of Owner or Agent Date <br /> Remarks, m X m0 <br /> t �Yl Ic �: I 1 <br /> 4 r.....: � .. ..' _°..... . >(•I elU...: ... :.:.I�) I. ..... .. .. .. ......... . <br /> ... a .l.l.�! . . . ...r. .... <br /> Inspection Date ....................................... U N o o m <br /> ................... <br /> M <br /> Zoning inistrate 8 . 8 8 0 0 fn <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 percolatimust be attached to <br /> this application before a permit will be issued. Do not purchase or install a septic tank, do any plu bing or start any build <br /> on <br /> test - <br /> ing until a permit has been issued. A permit may be revoked if misrepresentation of any of the inf rm ation conveyed here- <br /> with is found to exist. Changes in plans or specifications shall not lie made without approval of t e Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE ND APPROVED. <br />