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Burnett County Office of Zoning Administrator a <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT '' 3 o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as o <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use 7 <br /> m <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 n .� <br /> r..a.lt.........CQ.d . — <br /> �...... C ........... . ... . ¢ <br /> OWNER (Please Print) O .yt.. . ..................................................................................... <br /> / CONTRACTOR or SU RVEVOR or AGENT — hY O <br /> a <br /> a <br /> ...........,....Gt)A.S.L ............. riri !� <br /> ADDRESS ............................................................................................ a I <br /> ADDRESS <br /> A........................................................................................... <br /> DDRESS ....................................................................... <br /> ADDRESS ..................... <br /> ....................... ..................................................PHONE . .......................................................................................... <br /> PHONE <br /> PL........................................................................................... <br /> UMBER . .......................................................................................... �1 <br /> WELL DRILLER <br /> ........................................................................................... <br /> � v <br /> ADDRESS ............................................................... p <br /> ADDRESS <br /> P..H..O...N..E.. ............ <br /> o.......... .......................... . .................... . . ... KPHONE ..................................................... o — <br /> r <br /> DESCRIPTION z <br /> 1. Work: r <br /> 4. Sanitary Facilities: o o <br /> 2. New Building Details No. Bathrooms v <br /> New Building u Type of Construction: No. Bedrooms ° <br /> ......... . : a <br /> Addition Septic Tank Size Gals. <br /> .......... ................................................. .. <br /> Sanitary Size .............. ft. x .............. ft. <br /> Filling <br /> Height............. Stories ... .......... 4a. Absorption Field Site: >� <br /> Moving Area Soil T <br /> ......................................... Type ...........................I........ \..� <br /> Grading . .` o <br /> Slope .......................................... ,. <br /> Mobile Home <br /> 3. Use (describe exactly, 1 -family Pe rc. Rate ...................I............... <br /> Privy .......... home,garage, motel, etc.) Dry Well <br /> Well <br /> C.�.0. '6..................... Seepage Trench <br /> Subdivision """""" .......... t <br /> .......... Privy <br /> .................................................... <br /> --------------------__ Seepage Bed .......... <br /> Location of proposed structures and existing structures well, sewage systems, roads etc., should be sketched in Fig, .y 't <br /> setback, side and back yard dimension and location and setback from all bodies of water. If A. Include road Ce iC <br /> section, show the intersecting highways and the setbacks required along them and at the intersection rt CLEARLY LABEat a L EXISTING �y a <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. N <br /> _______ <br /> -------------------------------- > <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ft. x .............. ft. — ............................... sq. ft. <br /> e <br /> m <br /> _» <br /> 3 0 <br /> o <br /> o <br /> F(�aren ld <br /> ao'Kyo' / N z '` <br /> f o Mom rta I [ <br /> _'n <br /> n! 400 nq� ��r- • / C <br /> (� wetlnf d T be d.d : l <br /> V dto Cabe <br /> �o M Co r n N W Z <br /> McvEp -o' obr,E: C � a <br /> z o c : « * m <br /> . ............................................................ <br /> Signature of Owner or Agent """""""" <br /> 0 <br /> Date — <br /> : <br /> Remarks ..... .. : . <br /> �1 .....C'a �ti.......T..... b.e...........mav'e'd ......b <br /> : x <br /> ....... .... ti Is�—i ss m <br /> m <br /> O <br /> ........................................................................................................................................................................................ (A L <br /> ................................................................. <br /> Inspection Date ................. .. ('8j, <br /> T <br /> a �. <br /> ... ................./.."...... ............... .......... <br /> \ 000 <br /> Zoning Admini ator........VOTE: A preliminary site inspection must be made and site approval grantedon all structures involving sani[ary facili <br /> aefore construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br />:his application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build <br /> - <br /> ng 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 />