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Burriett County Office of Zoning Administrator on 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> 0 <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as 7 µ .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 m <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 c- <br /> :\l <br /> 1 / / r D _ n <br /> .....�:... . ................ . .. .ft.So!v...................................... .................P.......................................................................... <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT 0. <br /> n4ika fN:c ,{5r83d n <br /> ADDRESS,........................................................................... .ADDRESS .......................................................................... a .� <br /> .... .............................................................. <br /> ..... <br /> ADDRESS ADDRESS1 <br /> ............................................................................................ \. <br /> ........................................................................................... <br /> PHONE................................................................................ PHONE................................................................................. <br /> Ca <br /> PLUMBER WELL DRILLER <br /> C <br /> ADDRESS ADDRESS 0 <br /> . o <br /> : S <br /> ........................................................................................... ............................................................................................ o <br /> PHONE PHONE Z ai <br /> a r <br /> DESCRIPTION 4. Sanitary Facilities: t�.0 o <br /> 1. Work: No. Bathrooms v <br /> 2. New Building Details """"" <br /> New Building Type of Construction: No. Bedrooms .......... fd <br /> Addition .,,.,,, Septic Tank Size Gals. .......... <br /> ......... ...a.4.Kf..'F............................ <^ <br /> Sanitary .......... Size ....A....... ft. x ..:?.?:..... ft. .......... . <br /> 4a. Absorption Field Site: <br /> Filling/Grading ,,,,,,,,,, Height....`�....... $tO l s ............... <br /> Moving .......... Area .......3!.�s.;.F..� Soil Type .................................... : r <br /> o <br /> Mobile Home ........ Slope .......................................... <br /> Privy �!'..... 3. Use (describe exactly, 1 -family Perc. Rate ................................... ro <br /> Well .......... home,garage, motel, etc.) Dry Well .......... <br /> Seepage Trench I :\ <br /> Subdivision .......... ......... . "�. :� .......... :t <br /> �4.... ; .............................. Priv <br /> CampingUnit .......... .................................................... y .......... <br /> Seepage Bed .......... �- <br /> ---------------------------------------------------_------------------ <br /> Location <br /> ______ __________Location of proposed structures and existing structures,well, sewage systems, roads,etc.,should be sketched in Fig_ A. Include road <br /> 1 a a <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 n <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS is, N a <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... sq. ft. ........ t �, . �..�1' K, t-Q !,herh�� 1� fSo <br /> .........L..........a................................ <br /> (Oln6� �5�4-•-1 �(� �°- pp <br /> / N b O' <br /> O O <br /> ce \ <br /> —� E <br /> > o <br /> c � <br /> In 13 0 <br /> Va"'4✓i d i�0 <br /> l7t C <br /> /Y <br /> M Vl r to m Z <br /> tm' Q < m c m <br /> F <br /> q o N : °4 <br /> D a m <br /> ffl <br /> % o 1 <br /> p <br /> Signa ure of 'ncr or Agent Date <br /> X M <br /> Remarks m <br /> m <br /> to <br /> ........................................................................................................................................................................................ — <br /> �� II <br /> tP i <br /> ......................................................................................................... . <br /> ............. .............................................. ............... T <br /> Inspection Date ....................................... . ..LL?'.?Lo ............. �h-v <br /> Zoning Administrator C 8 8 8 8 8 8 <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 trust 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 Adm inistratot. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />