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Burnett County Office of Zoning Administratord 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 — �`, <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use c :� <br /> Ordinance, Sanitation and withallother applicable Count Ordinances and th�laws and regulations of the State of Wisconsin. 3 <br /> Q f� Y 9 / <br /> .. . ............. 1 .... .... ... �. ... ...... ...... ......./vt��1/Q� ...... ..... H ° <br /> OWNER (please print) <br /> NTP <br /> ,ill or URVEYOR or AG,ENT� m <br /> (.�... It 8oX 17d /.R a�c�r (/r/rsc <br /> . . .................. ...................................................... .. ............................................................................................ <br /> ADDRESS ADDRESS re <br /> Fr�e.dt. IL <br /> nii c rS C. <br /> ADDRESS . .......................................................................................... <br /> ADDRESSNj <br /> 'yrs - 397- 9 '7ct I <br /> . ............................................................. <br /> PHONE ............................................................................................ <br /> /iE/? ni Z11I-so t/ <br /> PHONE <br /> ......................................... <br /> PLUMBER ................................................ ............................................................................................ <br /> / WELL DRILLER :`AS <br /> ........./.u.... ..........V!!...�.f p <br /> ADDRESS ........................................... . . ...... . ............................................................................... m L) <br /> ADDRESS <br /> n o <br /> ...... .................................................................................. n � <br /> . .................................................Y..................................... . _. <br /> PHONE PHONE � (v � '�' <br /> DESCRIPTION o 0 <br /> 4. Sanitary Facilities: 3 o <br /> 1. Work: No. Bathrooms /j. E <br /> 2. New Building Details <br /> New Building y No. Bedrooms <br /> ..../.�... Type of Construction: a <br /> Addition .... ,,... .....fie/j/.h Septic Tank Size Gals. .......... i <br /> ........... .... < <br /> Sanitary .......... Size ....' ft. x ....1� ft. : <br /> Filling .......... Height...III.... Stories .....III......... 4a. Absorption Field Site: <br /> Moving .......... AreaSoil Type .................................... <br /> Grading ........................................... <br /> r <br /> 0 <br /> Slope .......................................... : .« <br /> Mobile Home .,.,...... 3. Use (describe exactly, 1 -family Pere. Rate ................................... i <br /> Privy .......... home,garage,. otel, etc n Dry Well .......... <br /> Well `a71// Cl <br /> .......... .�... fq.'ehf — �e Seepage Trench .......... <br /> Subdivision /fo I.Y.J �i Privy 'C- <br /> .......... . ...rru......t...�A. "......j3ceR.Ne. Seepage Bed .......... <br /> ----------------------------- ---------------- ---_--- <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 hack yard dimension and location and setback from all bodies of water. If property is located at a highway inter <br /> section, show the intersecting highways and the setbacks required along them and at the Intersection. CLEARLY LABEL EXISTING 5 <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> __________ __________________________________ __ <br /> 5. Lot Size: QQ� µI Fig. A. 6. Location: <br /> ft. x .............. ft. . .... ..r1S.!..!..t... sq. ft. ............................................................................... <br /> a <br /> N <br /> .2 961 N o <br /> y DRA o <br /> so' y 1° <br /> m iV <br /> t <br /> l yy Z . <br /> \� 96 r <br /> ( 9� <br /> ra $' �� re <br /> l W n EA Q <. m c m <br /> z oo' ° ' <br /> /t � — o — 83 i� m <br /> J <br /> Sig e off Owner or Agent ! Date uC <br /> Remarks ...U". I`......lo n s x m <br /> y..... .............. f...........................................� ............. \.............. <br /> .....�.�4.d.�..-... ..wµ ..#..�.syr.................................................... , <br /> o <br /> II <br /> Inspection Date ....................................... f c o 0 0 o o ri m <br /> :1....... ....�.......... ... ....... . 000000m <br /> Zoning Administ or o 0 0 0 0 o y <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, o 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 trade without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />