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Burnett County Office of Zoning Administrator d - o Z <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. 0 o <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as N <br /> shown herein. The undersigned agree that all work shall be done in accordance with the requirements of the Burnett County Land Use m c <br /> Ordinance, Sanitation Code, an w h all other <br /> 3 applicable County Ordinances and the laws and regulations of the State of Wisconsin. p_ pC. <br /> W45�11Y ..... ZL'f ✓ o <br /> ............. ...........................................................T............................... <br /> O ER (Please print) CONTRACTOR or SURVEYOR or AGENT Cl. m <br /> A DREss ................................ .............................................................................. d ' <br /> . .......... . <br /> ADDRESS <br /> G ! ...... '15�...................................... . .......................................................................................... <br /> AlD E ADDRESS <br /> .....3,.�................................................. . ................. <br /> ................... ............. ............. ......................... � <br /> PHONE PHONE <br /> ........................................................................................... .WELL..DRI........... .. .. ................................................................... <br /> PLUMBER LLER.. .... !� <br /> .... .............................................................................. ......................................................................................... <br /> ADDRESS ADDRESS 0 IV, <br /> . . .................................................................... .PHON..E................................................................................ o.o <br /> PHONE <br /> DESCRIPTIONo <br /> 4. Sanitary Facilities: o 0 ,I <br /> 1. Work: 2. New Building Details No. BathroomsJ' <br /> New Building .. Type of Construction: No. Bedrooms .......... `00 <br /> Addition aa Septic Tank Size Gals. ........... ........ ............. .. <br /> i <br /> Sanitary .......... Size ...7.. ft. x ,j..[.l... ft. • •••• <br /> Filling/Grading ........., Height..... Stories ............... 4a. Absorption Field Site: T.'t .`• <br /> Moving .......... Area ........................................... Soil Type .................................... <br /> Mobile Home .......... Slope .......................................... = .o+ <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Well home,garage, motel, etc.) Dry Well .......... <br /> Subdivision ....,,,,,, < Seepage Trench .......... <br /> .. . . .. ... <br /> Camping Unit ......... i� Privy .......... <br /> ... .......................I............I.......... -, <br /> Seepage Bed .......... <br /> ________ <br /> Location ofN <br /> proposed structures and existing structures well, sewage systems, roads etc., should be sketched in Fig. A. Include road C <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter l 7 <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTINGr S <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> ---------------------------------------------------------------------- <br /> 4 <br /> 5. Lot Size: Fi 9. A. 6. Location: l 'I o <br /> ft. x .............. ft. — .............`.............. s4.ft. ............................................................................... <br /> 1 i_ <br /> IN <br /> 0 <br /> 0 0 <br /> � J � <br /> O <br /> L \ 0 <br /> rl <br /> \M o <br /> Nd � FdwZ <br /> cr <br /> N d n W d m <br /> ` , cnc w ,� m c <br /> Z O D 5 n <br /> X35 I/ o <br /> . . .... <br /> p <br /> .......1. ...��, <br /> t c <br /> / x <br /> 9Rearks ..................................................................................................................................... m m <br /> ........................................................................................................................................................................................ <br /> ....................................................................................................... .. .. ........................ . .... ... ... <br /> ................................ <br /> T <br /> Inspection Date ....................................... 'o N o 'o rm <br /> Zoning Admi st�,-� . . . . . n <br /> S N <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 />