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„ , X 77J <br /> Burnet _junty Office of Zoning Administrator d 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. <br /> TO THE ZONING ADMINISTRATOR, The undersigned hereby makes application far a Permit for the work described and located as '� H 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 cel <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 t0a '� <br /> a <br /> © 1 .... R`.f:ma��Al........................................ ........S.4.. JF................................................................. f <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a <br /> .. ............. .......................... ............................................................................ a . <br /> ADD-RyEy�SS �.n ADDRESS <br /> sil,(1/' rt4.nl. S' ro <br /> RF9 . ,..:......... ... .......b..!z.....a.7.......................... ............................................................................................ <br /> ADO/RES [[�� c '7 p ADDRESS . <br /> .....tJ. .. ...........d..c ..7...:.3.A.h. ................................... ............................................................................................ � !� <br /> PHONE PHONE <br /> ........................................................................................... .......... . . . . ...................................................................... <br /> PLUMBER WELL DRILLER <br /> NN <br /> ADDRESS ADDRESS L7 <br /> n o <br /> rr <br /> ........................................................................................... ............................................................................................ o <br /> PHONE PHONE Z <br /> DESCRIPTION 4. Sanitary Facilities: ° oN <br /> °r <br /> 1. Work: 2. New Building Details No. Bathroomso <br /> .......... <br /> New Building ...X.... Type of Construction: No. Bedrooms .......... <br /> Addition ,......... ........P'IS'.A: I.S............................ Septic Tank Size Gals. .......... .� <br /> Sanitary .......... Size ....LY..... ft. x ......? ft. <br /> FillingiGrading ,,,,,,,,,, Height............. Stogies ....L......... 4a. Absorption Field Site: <br /> Moving .......... Area .........Y�.(.6....] .. t�......... Soil Type .................................... 0 <br /> /i 0 <br /> Mobile Home r” Slope .......................................... .+ <br /> Privy ,,,,,,,,,. 3. Use (describe exactlyPerc. Rate ..................................., 1 -family <br /> Well .......... home,garage, motel, etc.) Dry Well .......... <br /> Subdivision d fq�. Seepage Trench .......... <br /> Camping Unit .......... �. .. .....7 Privy .......... <br /> .................................................... Seepage Bed <br /> Location of proposed structures and existing structures well, sewage systems, roads etc., should be sketched in Fig A. Include road e <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- w Las 1: <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING X. <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. p <br /> ------------------ --------------------------------------------------- <br /> J <br /> 5. Lot Size: Fig. A. 6. Lpcation: ,g O� <br /> ................ ft. x .............. ft. — ............................... sq.ft. ,,,]EF......lTTA7.6.!}�/!.......jJ1.1..:..................... <br /> cn <br /> R \J f0 <br /> N 5 <br /> Ir a <br /> J 0� <br /> Jr <br /> Ir v <br /> I / v <br /> d <br /> A.f' cvV'� <br /> (j!\ � 7a be r Wm <br /> Q z <br /> tm' c < 0 c m <br /> N so 51: d d tD <br /> Z 00 � D n <br /> oD n 3 <br /> y _ <br /> — m <br /> Lie 1, . ..�G�?. .... .. ........... ... <br /> gnature ... 5..-. Z..(c.. ..//�t� <br /> _ m <br /> p <br /> Siof Owner or A nt Date �o C <br /> X <br /> Remarks ......................................................................................................................................................................... m m <br /> v <br /> in <br /> ........................................................................................................................................................................................ — <br /> II <br /> ............................................................................................................ ... ............... .. .............................. :� <br /> Inspection Date �..... \ <br /> �. UNONo " m <br /> ... <br /> Zonin dministrator 8 $ S 8 $ $ v� <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, it 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 Adm inistrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />