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J1 I I` �✓/ <br /> Bull ,.,._^ty Office of Zoning Administrator c `00 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 ano <br /> d located as '� — <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 ;YY�`` <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a :'v <br /> O <br /> re ..........:4t.1. k[ .................. ............ .................... <br /> ............................................ ........................................ F <br /> . . <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT m <br /> n v <br /> + Z a <br /> ADDRESSADDRESS <br /> IID ,S <br /> 4�..e.. ...........r.....,.w. ............ ........................... . . . . . ................................................................................. int <br /> ADDRESS ADDRESS :Q— <br /> PHONE................................................................................ .PHONE................................................................................ <br /> e�5...........�'e...{..0............................................... ............................................................................................ <br /> PLUMBER WELL DRILLER : 1 <br /> .......W.-L6 .r. o � <br /> .. .......................................................... . . ...... . ............................................................................... <br /> ADDRESS ADDRESS <br /> (... ` S o 0 <br /> 8 <br /> PHONE PHONE <br /> Z r; <br /> DESCRIPTION 4. Sanitary Facilities: P o ° <br /> 1. Work: 2. New Building Details No. Bathrooms ... o <br /> New Building .......... Type of Construction: No. Bedrooms .. .... i a <br /> Addition .................................................... Septic Tank Size Gals. .......... <br /> Sanitary ..x..... Size .............. ft. x .............. ft. .......... :� :(J3 <br /> Pilling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area Soil Type .................................... r <br /> ......................................... <br /> Mobile Home Slope ............++yy _ ;,X <br /> Privy .......... 3. Use (describe exec , 1 -family Pere. Rate ......J... ...... . .......... <br /> Well om ,garage, motel, etc. Dry Well .......... <br /> .......... <br /> Subdivision .......... ..........................................I......... Seepage Trench .......... <br /> Camping Unit .......... Privy <br /> .................................................... A <br /> Seepage Bed <br /> __________________________________________________ ___--------_ `1, <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched in Fig. A. Include road els' 9 <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- _o- <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. 1 <br /> --------------------------------------------------- -------------- --................................................. ?f\ �� <br /> o <br /> 5. Lppj{ Size: 0 Fig. A. 6. Location: <br /> `jQQ... ft. x�.S... ft. — s ft. <br /> 00 <br /> N <br /> O IT <br /> y O <br /> 0 <br /> C <br /> 0 (>> <br /> S N r 9 W Z <br /> n Q < W c m <br /> _ F <br /> m N a a m n <br /> a� to <br /> cin <� C � ,e c 'V <br /> D a <br /> m <br /> 0 o nro3 <br /> S � �S � o p <br /> Signature of Owner or Agent Date » <br /> X 77 <br /> m <br /> Remarks ............................:............................................................................................................................................ <br /> n <br /> ..............................................................:............................................. ... ........ . . : r . . . . . . <br /> T.. .... . ....... . ...................................... <br /> .Ip. <br /> � N � � � Nm <br /> Inspection Date ....................................... .. ............ ................. ..................................... o u• o u, o v, m <br /> Zoning rhmistrator $ $ $ $ $ $ rn <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 />