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Burnett County Office of Zoning Administrator r 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. <br /> 0 <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 become in accordance with the requirements of the Burnett County Land Use m c <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the�laws and regulations of the State of Wisconsin. 3 a <br /> �ul. .. o <br /> W ....... J,4 .4i.t?.�..0?k1..........oSi2....... ....... c. '..`'.p.nS ............................................... a <br /> OWNER (plEase print) .. y CONTRACTOR or SURVEYOR or AGENT m <br /> �c .l.�......V9J . y....Al i..1.).................. ............................................................................ d �' <br /> ADDRE S ADDRESS � � ., <br /> i <br /> . ....�p Tc.s ..L'a u e r........................ ............................................................................................ F <br /> ADDRESS ADDRESS <br /> ........................................................................................... ... .NE.................................................................................... � :n <br /> PHONE PHO.... sr\� <br /> ........................................................................................... .W..EL.....L... ... <br /> D..RI. ..LLER.... .................................. <br /> ....... <br /> ..... <br /> ....................... {;i <br /> PLUMBER <br /> ............................................................................................ 0 <br /> ADDRESS ADDRESS ' <br /> n o i <br /> ........................................................................................... ............................................................................................ :Z N' r: <br /> PHONE PHONE x' <br /> DESCRIPTION 0 <br /> 4. Sanitary Facilities: ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms <br /> .......... <br /> New Building No. Bedrooms .......... <br /> .......... Type of Construction: ' <br /> Addition Septic Tank Size Gals. <br /> Sanitary .......... Size .....�a... ft. x ....a2 y.... ft. .......... <br /> 3 <br /> Filling/Grading .......... Height...ja.... Stories 4a. Absorption Field Site: <br /> Moving Soil Type .................................... <br /> .......... ........................................... F r <br /> Mobile Home Slope A <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Well .......... home,garage, motel, etpp.) Dry Well .......... <br /> Subdivision (�,� Seepage Trench <br /> ,,, ,,,,,, J" <br /> Camping Unit ..... ..:M(1I. F/.`:�.1.. ........................... Privy .......... AI <br /> ..... ........-.......................................... <br /> 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 back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- lu a <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING °1 <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. 0 0ist <br /> ------------ <br /> 5. Lot Size: Fig. A. 6. Location: n <br /> N <br /> ....;.L�.f�... ft. x ...!.�.s:5 ft. — ............................... sq.ft. ............................................................................... <br /> (� 0 <br /> I o <br /> - - — , iJ <br /> s o <br /> i <br /> Z <br /> a <br /> Cl) r v N W <br /> IQ <br /> fA n <br /> 'o cnn a' C 'a n 'D <br /> am . m <br /> Z O <br /> n 3 <br /> o 31 <br /> 1% m <br /> P � O <br /> Signature df Owner or Agent r1 Date x . <br /> Remarks �lfJ..�a ..�s`.....70 / m O <br /> ............................................................................................................. m : <br /> m : <br /> ..................................................................................................................................................................I..................... <br /> n <br /> Inspection Date T r ^' m 8 N m <br /> .nn...II..��..''..�^.,... .�.//.J ` <br /> P ....................................... .w!!F�'c� ! ............... ... . '.... .......................... :1 rn o a o a <br /> M <br /> Zoning Aid mi strator FJ i i 8 8 $ $ 8 m <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary fdCilltieS <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 />