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Burnett County Office of Zoning Administ ator o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3 <br /> o .� <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and loc ted as < N µ <br /> shown herein. The undersigned agrees that all work shall be done In accordance with the requirements of the Burnett County Let of Use <br /> %dce, anta Ion Cade, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin 3 <br /> Sanitation <br /> �..... ��.h . I ( Ja.... .... .. u.r�..... <br /> Q, <br /> OWNER (please t) CO TR TOR or S VEVOR or A <br /> A5.`.11....i ..:� - .... .�................................................. ......... d :� <br /> ADDRESS _ ADD ES I <br /> ...IL.,...m.��...... .�.o.l............... ...Lu�Pr,... . �lg ....... ......... © � <br /> ADDRESS ADDRESS <br /> ........................................................................................... . ................................................................................ ......... ) <br /> PHONE PHONE <br /> PLUMBER............................................................................ .WELL DRI LLE. ...................................................... ...... <br /> O <br /> ........................................................................................... ...................................................................I.............. ......... _. <br /> ADDRESS ADDRESS n c <br /> 0 � <br /> ........................................................................................... ... ........................................... ..... ........................... ......... o .: <br /> PHONE PHONE.. Z r <br /> DESCRIPTION 4. Sanitary Facilities: ° o o <br /> Bathrooms <br /> 1. Work: 2. New Building Details No. Bat """' o =� <br /> New Building No. Bedrooms <br /> ,,,,,,.,,. Type of Construction: """"" <br /> Addition ...I...... .................................................... Septic Tank Size Gals. .......... <br /> Sanitary .......... Size ft. x ft. """"" ' <br /> FillinglGrading ........ Height............. Stories ............... Soil Type4a. Absorption Field Site:................... .... ......... <br /> . ... r <br /> Moving .......... Area ........................................... o <br /> Mobile Home Slope ............................... .......... <br /> .......... <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ........................ .......... i <br /> Well .,,,,. .. home, garage, motel, etc.) Dry Well .......... <br /> 1 <br /> Subdivision Seepage Trench .......... i i f <br /> .................................................... <br /> Camping Unit Privy .......... <br /> Seepage Bed .......... <br /> ---------- -- Q i N <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc-, should de sketched in Fig A- Include road I Q <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter 0- <br /> section, show the Intersecting highways and the setbacks required along them and at the intersection_ CLEARLY LABEL EXISTING <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o <br /> ------------------------------------------------------------ --- '1' <br /> 5. Lot Size: Fig. A. 6. Location: <br /> -----____ <br /> ................ ft. x .............. ft. . ............................... sq. ft. ................................................................... ........... lI l> <br /> or <br /> N + o <br /> YOI P-TS 133- 0 <br /> 0 <br /> Z <br /> DO <br /> ei a n i m o s <br /> m <br /> — rt <br /> D a x <br /> O O n b <br /> rr <br /> rt <br /> Signature of Owner or Agent Date �^ <br /> X 7 <br /> Remarks ................................................................................................................................................................ ........ .a C <br /> m <br /> of <br /> ... <br /> ............................ ................................................................................................................................................ ........ — <br /> ......................................................................................................... ..................... ... .... .. ........ ..................... ........ O ;O . . . . . <br /> + . rt <br /> + Nn <br /> Inspection Date ....................................... . . .. . . . MLt!. .... . ...... . o u o u, <br /> (by U U <br /> Zoning Adminis for 0 0 0 0 0 0 0 <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures nvolving 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 hete.- <br /> with is found to exist. Changes in plans or specifications shall not be made without approval of the Zoning Adm inistratol . <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />