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�.fl?•-,C,�r�t�i <br /> Burnett County Office of Zoning Administrator d 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 Q <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as N :U\ <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m t: <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> i �r..►r. ...... ..:...��.rr.�SrrlA.✓1.......................... .................................................... N a o <br /> . . . ...... . . .......... ...... . . . <br /> OWNER (Plea a print) CONTRACTOR or SURVEYOR or AGENT oi <br /> O <br /> pp Q � -7 o <br /> I1� ... ....C7A.X. . 7 .............................. .............. ............... .... I........................ a <br /> ADDRESS ADDRESS .°i. <br /> 2Qan.b..�,r. Lc� ......54830 <br /> (�",�J . . .......................... <br /> ESS t ADDRESS <br /> ..........7.t.5.-....5.4...-.�..f..a..3............................. ............................................................................................ <br /> PHONE PHONE <br /> . .......................................................................................... .� <br /> PLUMBER WELL DRILLER <br /> Q <br /> ........................................................................................... ............................................................................................ _. <br /> ADDRESS ADDRESS m G) <br /> n o <br /> ........................................................................................... .PHONE........................................................................................... Z o .: <br /> PHONE <br /> r <br /> DESCRIPTION 4. Sanitary Facilities: ° <br /> 1. Work: 2. New Building Details No. Bathrooms .......... -o <br /> New ewimng .....,,,. Type of Construction: No. Bedrooms .......... <br /> AdditionSeptic Tank Size Gals. <br /> .......... <br /> Sanitary Size ft. x ft. .......... x" <br /> Filling/Grading ,..,,,,,,• Height............. Stories ............... 4a. Absorption Field Site: i E <br /> i <br /> Moving Soil Type ................. <br /> .......... Area ........................................... ................... <br /> W: r <br /> Slope ° <br /> Mobile Home .......... P .......................................... f.1 .. <br /> Privy ... ...... 3. Use (describe exactly, 1 -family Perc. Rate ..........................I........ <br /> Well ,. .... home,garage, motel,etc.) Dry Well ......... <br /> vt <br /> Subdivision .......... Seepage Trench .......... a <br /> Camping Unit .......... .................................................... Privy <br /> C <br /> .... <br /> .................................................... ...... <br /> Seepage Bed .......... t E <br /> ---------------------------------------------------------------------- <br /> Location of proposed structures and existing structures,well,sewage systems, roads,etc., should be sketched in Fig. A. Include road 1 <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- a <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. 4 N <br /> ------------------------------ O <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... sq.ft. ............................................................................... <br /> J <br /> N o <br /> ° <br /> ° W : '3 <br /> ki <br /> Foil <br /> el�tV�q F <br /> 0x11 ' a ds J1 <br /> �l� <br /> SOV) � . (SQILyFI( o <br /> Drain�ield <br /> n r a m z <br /> E <br /> Zp'^. m D n m <br /> 00 <br /> O 7 n m 3 <br /> EA <br /> Kurn ner or Agent Date <br /> yvRemarksS .. ................................................................ T!. <br /> M <br /> ........................................................................................................................................................................................ o ' . . <br /> ....................................................................................................... .. : : : : : : <br /> Ins m <br /> o: <br /> o: <br /> Inspection Date ....................................... o o' <br /> P .. .................. ................................... <br /> Zoning Ad inistrator`�U 8 8 8 8 8 8 VJ <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 />