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Burnett County Office of Zoning Administrator d - o 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 o <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 Ordinance, Sanitation ode,and with all other <br /> applicable.County Ordinances and the laws and regulations of the State of Wisconsin. 3 n <br /> F�or��t�e e -TnCk I/�c k N a o <br /> .................................................... ........�TQ....tv`. . ............................................................................................ <br /> OWNER (please print) s CONTRACTOR or SURVEYOR or AGENT a <br /> �. L�.�X. $. ...... if� JF !.G......�iYlse ............................................................................................ <br /> ESS S(�&37 ADDRESS <br /> \ i <br /> ........................................................................................... <br /> . ......R. . ..ESS............................................................................. W <br /> ADDRESS ADD <br /> ONE ........................................................ ............................................................... ....................... .... <br /> PHONE. ............................................................................... PHONE <br /> . . ............................................................................................ _\ <br /> PLUMBER WELL DRILLER <br /> ........................................................................................... .ADD.. RESS.....R-ES".............................................................................. <br /> ADDRESS io L) <br /> n o <br /> ........................................................................................... ............................................................................................ o' <br /> PHONE PHONE Z N <br /> DESCRIPTION 4. Sanitary Facilities: ° o 0 <br /> 1. Work: 2. New Building Details No. Bathrooms v ; <br /> ........,. r;: o <br /> No. Bedrooms aVJ <br /> New Building Type of Construction: �••••�•�•• <br /> Addition Septic Tank Size Gals. ` <br /> .......... ....... .............I......I....................... <br /> .......... <br /> Sanitary .......... Size .............. ft. x .............. ft. i <br /> Filling)Grading •„•...... Height........... Stories ............... 4a. Absorption Field Site: <br /> Moving Soil Type ..................... <br /> .......... ........................................... ............... <br /> Mobile HomeSlope O o <br /> Privy ,,........ 3. Use (describe exactly, 1 -family Pere. Rate ...........................I....... <br /> L ' <br /> Well ...I...••. home,garage, motel, etc.) Dry Well .......... i <br /> Subdivision ,,,,,,,,,, Seepage Trench .......... <br /> Camping Unit .......... .................................................... Privy .......... <br /> Seepage Bed .......... _ <br /> ______________________________________________________________________ 00V1 <br /> Location of proposed structures and existing structures,well, sewage systems, roads, etc., should be sketched in Fig. A. Include road <br /> setback, side and back property g to <br /> yard dimension and location and setback from all bodies of water. If ro erty 'rs 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 /> a <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS 13 <br /> --___-----_— ___--_ <br /> 5. Lot Size: p'[y Fig. A. 6. Location: (( i <br /> ................ ft. x .............. ft. . .... I �..J.1/....... sq. ft. ..........y..>..J,C.fir. LGQ.r.Q.d...U....�?N......... ? i <br /> Application for land use camp ' g permit from May 1 , 1985 to d <br /> November 1 , 1985 . <br /> N o <br /> 0 <br /> 0 <br /> 16Rt1�! s <br /> �7 Mq a :its a <br /> J p O <br /> 71 <br /> N_ <br /> m m <br /> m toocr. n < `D �. ? F <br /> T.z oo a3' <br /> n � M 7C1 <br /> in - <br /> S/ SOU � � <br /> : <br /> .... ........ ......................... ............... .................... :v o C <br /> Signature of Owner or Agent Date <br /> Remarks QC..,G?�.GO. x -M <br /> m : <br /> ........................................................................................................................................................................................ - <br /> ......... �. �... <br /> ' . <br /> li <br /> ................................................................. .............................. : 1 . . . . . . <br /> Inspection Date ....................................... S <br /> M <br /> ......... . . .C................... <br /> ZoningAdInistrato' ✓ <br /> $ $ 8 8 $ 8 y <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures Involving sanitary facilitiuc <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 />