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„ unty Office of Zoning Administrator �' o a <br /> APPEICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3. <br /> o �OZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as y <br /> herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m C <br /> -rdinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 cL :d <br /> E1QIQ.. . .FZ$69R...................................... ............................................................................................ <br /> Jy� f <br /> OWNER (plea5€'print) CONTRACTOR or SURVEYOR or AGENT n <br /> a <br /> ., -..y..,... X. y. ............................ ............................................................................................ d <br /> ADDRESS ADDRESS <br /> / Sy9"q <br /> 5•.......................................... ............................................................................................ c,� <br /> ADDRESS ADDRESS .� <br /> PHONE................................................................................ ............................................................................................ <br /> PHONE i <br /> i <br /> N............................. ............................................................................................ <br /> PLUMPER WELL DRILLER \ i <br /> 2 LtI� lt1l r S�! <br /> /[4`^/ .. . ................ ............... .. .. �..� ............................................................................................ <br /> ADDRESS...... ADDRESS i t., <br /> ........................................................................................... .....ONE.... .......................................... ....................................... "J O <br /> PHONE PHH <br /> Z r <br /> DESCRIPTION 4. Sanitary <br /> Facilities: ° o <br /> 1. Work: No. Bathrooms ...... <br /> 2. New Building Details :( o <br /> New Building Type of Construction: No. Bedrooms ....�/... :-142 'o <br /> Addition Septic Tank Size Gals. ,rr <br /> Sanitary .... Size .............. ft. x .............. ft. <br /> .......... <br /> Filling .......... Height............. Stories ............... 4a. Absorptio Field ite: <br /> E <br /> Moving Area .. <br /> soil Typ >` •• /IJP ; o <br /> .. .................... <br /> Grading Slope ......I�..CF.. .................... <br /> .......... <br /> Mobile Home Perc. Rate .....4. ....................... E E <br /> .,........ 3. Use (describe exactly, 1 -family ; <br /> Privy home,garage, motel, etc.) Dry Well <br /> Well .......... Seepage Trench .......... <br /> Cr <br /> Subdivision y <br /> ................................................... Priv /O�X Ali...... i4 <br /> Seepage Bed .,.. ;^ <br /> ------- ------------------------------------------------#��-d.--..... <br /> Location of proposed structures and existing structures,well,sewage systems, roads,etc.,should be sketched in Fig. A. Include road •`-�”'111 <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- ;� �;• v 11 <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING 1r� <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. O o <br /> ---------------------------------------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: �N, <br /> ................ ft. x .............. ft.— ............................... sq.ft. .............................................................................. <br /> P)N <br /> O 7 <br /> Lo <br /> 0 <br /> CD <br /> d <br /> M inr -� Wz <br /> ted , d <br /> to < C_ : :3 <br /> rn <br /> o p 6 m m <br /> 60 5'3 <br /> 01 <br /> O o <br /> p <br /> .. o <br /> Signature of Owner or Agent Date <br /> X <br /> Remarks ......................................................................................................................................................................... -n : c c i m <br /> v <br /> ........................................................................................................................................................................................ � 11 <br /> r>uo 7 <br /> ... . . .. ... ........ . .......................................... <br /> N-n <br /> Inspection Date .................................... .: . ......... ....... .... ...9...... ......f..-.......K..,�................. o 0 0 0 o w m <br /> .......... . ....... <br /> p <br /> Zonin Administrator o 0 0 0 0 o CA <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 />