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C/ <br /> /� i / " <br /> Burnett County Office of Zoning Administrator / 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> o <br /> TO THE ZONING ADMINISTRATOR; The undersigned hereby makes application for a Permit for the work described and located as 'c — <br /> shown herein. The undersigned agrees that all work shall become 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 <br /> ././...GNWizCE'/.pC!`� ........................... 1.P..\ ....... .. .......................... m , <br /> O <br /> .......................... ..... ...... .......... ............. <br /> OWNjER//(please—print) /7 CON FACTOR or SU EVOR or AGENT a ��J <br /> .'........................ .. ...Zp�... ................................... <br /> m <br /> ADDRESS AD ESS <br /> o°. �•ra ✓ Ss ..3 <br /> 7.............. .... <br /> ADDRESS ADDRESS ' <br /> ........... <br /> ........................................................................................... ................................................................................. N <br /> PHONE PHONE � <br /> ........... <br /> ........................................................................................... WEL. . . ..L...DR... ....ER........................................................ .... U <br /> PLUMBER IL.. L \ �—J <br /> ........................................................................................... ............................................................................................ � n <br /> ADDRESS ADDRESSC <br /> .; <br /> ........................................................................................... ... ................................................................................... : o' <br /> PHONE PHONE...... Z <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: No. Bathrooms I <br /> 2. New Building Details """"" c ? <br /> 9 <br /> New Building No. Bedrooms <br /> ......•... Type of Construction: ••••'"•" <br /> Septic Tank Size Gals. <br /> Sanitary .......... Size .............. ft. x .............. ft. .......... <br /> Filling/Grading .......... Height............. Stories .......................................................... 4a. Absorption Field Site: <br /> Moving .......... Area Soil Type .................................... o <br /> Mobile Home i <br /> Slope .......................................... <br /> .......... <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Well .......... home,garage, motel, etc.) Dry Well .......... <br /> subdivision ,✓„ Seepage Trench .......... i <br /> Camping Unit .......... .................................................... Privy <br /> Seepage Bed .......... . <br /> -------------------------------------------------- --------------- ---- <br /> I N <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. Include road 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- W o- <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING y <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o' <br /> ---------------------------------------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: Q <br /> ................ ft. x .............. ft. . ............................... sq. ft. ............................................................................... <br /> P <br /> N <br /> N o o <br /> a <br /> i t <br /> r� (� o <br /> m <br /> mF <br /> r v m m Z <br /> c < m c m <br /> Q F <br /> 'O � O. m � m � <br /> m <br /> -' m <br /> 0 <br /> off. yn <br /> 0 [1 d 37 <br /> m <br /> 'y O m <br /> /0 -e?cJ- �S €r " p <br /> ........................................................................... ...................................... ? o C <br /> Signature of Owner or Agent Date x <br /> Remarks ......................................................................................................................................................................... m m <br /> eis ° <br /> ........................................................................................................................................................................................ <br /> ....................................................................................................... ... ................�.... :ut <br /> .p......................................... <br /> Inspection Date ....................................... ..............'/ . . . �cCZ.�c •¢�z!....� ? a $ 8 8 8 8 8 8 m <br /> ..... . . ......9 .. ........ ............. <br /> Cn <br /> ./ <br /> Zoning Admi istrator <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 tie made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />