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Burnett County Office of Zoning Administrator 0 1 0 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 < 7 Q <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m c <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 0 V <br /> `` O <br /> LUJ.Sh.D.Io.S.....K�virv..... .V..e.l.�.�..r................. ... e.Q.�.1.�.s....... o.w.�. 1-... ...s..� .1.. ............ 7C <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT 3. <br /> .an1 <br /> W......Ica,/ . ...A....�.3�d .W.e b..�....�-r?.��..� ................................................ 0, ��P. b <br /> ADDRESS ADDRESS <br /> 5.7..........Pa..V...�....�..! 1.!J....... .5 -................ ............................................................................................ <br /> ADDRESS ADDRESS <br /> ............................................................................................ <br /> PHONE. ............................................................................... PHONE <br /> . . ............................................................................................ <br /> PLUMBER WELL DRILLER <br /> . . ...... . ............................................................................... O <br /> ........................................................................................... —. <br /> ADDRESS ADDRESS m O <br /> PHONE PHONE Z r <br /> DESCRIPTION4. Sanitary Facilities: ° o ° <br /> 1. Work: No. Bathrooms ' <br /> 2. New Building Details .••.•••••• o <br /> New Building .,,x... Type of Construction: No. Bedrooms .......... i <br /> Addition A,q„ w to Pi✓{✓ Septic Tank Size Gals. .......... <br /> �..ca.r....Ga.r... Q.....�............ <br /> Sanitary .......... Size .y..... ft. x ... .y.... ft. .......... <br /> Filling/Grading .......... Height.A.... Stories ............... 4a. Absorption Field Site: <br /> �i <br /> Moving .......... Area Soil Type .................................... ;z_' r i <br /> ........................................... o <br /> MobileHome Slope .......................................... .+ <br /> .......... <br /> Privy .......... 3. Use (describe exactly, 1 -family Pere. Rate ................................... (A <br /> ......ll We .... O <br /> Well ,......... home,garage, motel, etc.) Dry <br /> Subdivision .......... .gfa. ..................... PfIV <br /> Seepage Trench .......... <br /> ........ <br /> Camping Unit y .......... — \ <br /> .. .................................................... <br /> Seepage Bed .......... :\ <br /> —————————————————————————————————————————————————————————————————————— <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched in Fig. A. Include road I e <br /> 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- � � °- <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. (_ <br /> I ( o <br /> ---------------------------------------------------------------------- <br /> �O <br /> 5. Lot Size: GG Fig. A. 6. Location: r� <br /> 3.3.,311..... ft. x 122..3. ft. . ............................... sq. ft. ............................................................................... nx, :0 <br /> vist <br /> zt <br /> er n <br /> N P O <br /> O J <br /> J <br /> as <br /> TI <br /> Q <br /> O <br /> i <br /> ri <br /> T :e <br /> av zy 5ara9.v�Z t, Irl' Z <br /> 0 <br /> /OyX /Jrtdydtwy l eN( rl' <br /> U e r r e— <br /> a <br /> r <br /> L IIN <br /> IN/J ow �ru � r1- <br /> U O ��QV 6U1 '�J Ci $ M � to r�v � � m <br /> W n < c m <br /> 4 <br /> C <br /> m D — <br /> Z o o <br /> o —J a <br /> IM <br /> ............. <br /> Signature of Owner or Agent Dafe `C o C <br /> 70X <br /> Remarks ......................................................................................................................................................................... m m <br /> v <br /> it a <br /> ,........................................................................................................ ..................................... .................... ................ x",e s « m <br /> Inspection Date ....................................... ..a. . .... m <br /> Zoning Administrator 8 8 8 8 8 8 0 <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 />