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_Sl�'?1�-nom <br /> Burnett County Office of Zoning Administrator tn 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 -c 7 :9,u <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use V <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 p- <br /> ........... <br /> :(y <br /> .a�. ....... ....k ..o.1.m.b.e.+'.. ........... .......�.row...... . ... .. ............................ <br /> p Q{ a <br /> OWNER (please print) l CONTRACTOR or SURVEYIDR or AGENT <br /> Soy........J.? - ..... �t.... .......................... P o �a�c. t� a � o <br /> ................................ ... ............9..................................... , <br /> ADDRESS ADDRESS p <br /> ... ....gin e . .............. ... ].. ............�.............................. ............................................ <br /> ADDRESS t ADDRESS <br /> ..................�.1.�.-...s.. �. ...3` z.s......... .. ........... ............... 4 ........yl..o..l............................................. T <br /> yp <br /> PHONE — / ,�-Tt� PHONE \ i <br /> .. . ...... ...................................... 2..."'4 . ...... .. . . ....................................................................... :U <br /> PWMRER WELL DRILLER <br /> ........................................................................................... .ADDRESS........................................................................................... <br /> ADDRESS <br /> n o <br /> C < <br /> . . . . . . .................................................................... ............................................................................................ o' <br /> PHONE PHONE <br /> Z � r <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° ' <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details o <br /> New Building Type f Construction.(/ No. Bedrooms .......... <br /> Addition ......,, Septic Tank Size Gals. .......... V1............. <br /> Sanitary .......... Size .... . ft. x ..Z.y. ... ft. <br /> .. 4a. Absorption Field Site: <br /> Filling/Grading .......... Height..... StOri s ............... <br /> Moving .......... Area 5. ':... Soil Type .................................... (a :� 0 <br /> 1 <br /> Mobile Home .......... Slope .......................................... � O o <br /> Privy .......... 3. Use Wesera exactly, 1 -family Perc. Rate ................................... <br /> Well ,,,,,,,,,, home aro motel, etc.) Dry Well .......... <br /> Subdivision .,...,.,.. Seepage Trench .......... , <br /> Camping Unit .......... ��M' ,' Seep .......... <br /> ............... ..`....^m�""................ <br /> Seepage Bed ......... <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- a <br /> section, show the intersecting highways and the setbacks required along them and at the intersecnon. CLEARLY LABEL EXISTING .� <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. yy p' <br /> � <br /> —_ --------------------------------------------------------- �- <br /> i Z <br /> 5. Lot Sze: Fig. A. 6. Location: .V� <br /> .oZ. �...1..... ft. x .... ft. — ............................... sq.ft. <br /> ....k 54'A.........................................................., <br /> �ASf s <br /> �A N � O <br /> L2_11 <br /> o�om <br /> Zy71t <br /> T : y m ZC m� cZ O On0 � �i» _» 3 <br /> C, <br /> AK C R m <br /> ..... rOtw ...... ,g.:�.............. ....j..c..'.I.1.-.8.5..........• _ p <br /> Signature of Owner or Agent Date ° C <br /> X <br /> / ea .tar. Aar\\ In : m <br /> Remarks ���.....adGs.....................k'9C........f.................................................................................................................. m <br /> n <br /> ........................................................................................................................................................................................ q II <br /> ......................................................................................................... . ...............�.1 . . . . . . <br /> Inspection Date ....................................... 1YG.�Q..l........ /...:`J"�' .,.. '�...................... dl u tin 'o ,u�. o tin m <br /> Zoning Adm of istrator KJ 8 0 0 0 o S Cn <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 />