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Burnett County Office of Zoning Administrator V A o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. <br /> o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as �T -^ <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use aO <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a �. <br /> w.9 ..... .. f �crG...................... ................................... ............................ — o <br /> OW R (please print) CONTRACTOR or SURVEYOR or AGENT a <br /> -../................. .... <br /> .............................................................................................. <br /> AD9.H.H ESS ADDRESS � <br /> l.Rn!.. ..411✓s................................................. . .......................................................................................... <br /> ADDRESS Z ADDRESS <br /> .� -....ds ..-... ..� ........................... , <br /> PHONE PHONE b <br /> .......... <br /> ........................................................................................... .WE...........RI.....LL...E............. <br /> .................................... <br /> ............ <br /> PLUMBER LL DR <br /> O i <br /> .......... <br /> ADDRESS............................................................................ . S <br /> D <br /> ADRES ............ <br /> ...... <br /> .............. <br /> ................................ <br /> ... » o <br /> ........................................................................................... . ................................................. ....................................... O ri <br /> PHONE PHONE Z H r <br /> DESCRIPTION 4. Sanitary <br /> Facilities: ° o ° <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details """"" <br /> New Building Tape of Constructions 1' No. Bedrooms .......... <br /> Addition J.Q-Rti<.fi.✓..E.�...../9.Z.c.h.. Septic Tank Size Gals. .......... E E <br /> Sanitary .......... Size .............. ft. x ft. .......... <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area ........................................... Soil Type ................................ C' O <br /> Mobile Home .......... Slope .......................................... 3 <br /> . . <br /> Privy .......... 3. Use (describe exactlyPere. Rate .................... ............ . <br /> , 1 -family <br /> Dry Well ......... i� <br /> Well .......... home,garage, motel, etc.) . n <br /> Seepage Trench <br /> Subdivision .......... .................................................... Privy .......... <br /> CampingUnit .......... .................................................... Seepage Bed <br /> r <br /> ---------------------------------------------------------------------- <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc.,should be sketched in Fig. A. Include road `i 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- U a � <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING <br /> p <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS.---------------------------------------------------------------------- <br /> o <br /> 5. Lot Size: Fig. A. 6. Location: pp } <br /> ................ ft. x .............. ft. — sq.ft. .....L.T W fScT .2� E <br /> P <br /> t! <br /> N O <br /> o <br /> � 0 <br /> O of <br /> / a E <br /> / .6 / G /N :X) T <br /> y° So A E� 5 <br /> LIJ <br /> Z <br /> *N / o <br /> h ) 0Vv2 /00 / �o/"J d <br /> 0 tv <br /> M op r M br W Z <br /> n Q < <br /> m N O C <br /> m <br /> o <br /> Z 3n . 9 <br /> o a 3 <br /> F» - <br /> cn S -i <br /> E�o <br /> „ ................................. .................................... <br /> ignature of�7 caner-or/ent Date <br /> X — <br /> Remarks...J �t p <br /> ..,err..�2.e'n�n:c..T�`....�?':...��..�.7..Y................................................................................................................ m <br /> ............................................................................................................. .... ........ <br /> ..... .... . <br /> ...................................... <br /> Ic <br /> ...................... O: M <br /> Inspection Date ....................................... .... . ..... ...... .. ... ......... i o o rmrl <br /> ZoniIn Ad Istrater 8 8 8 8 8 8 in <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 />