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t N Cc, rfl r <br /> Burnett County Office of Zoning Administrator d o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 377— <br /> C <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as C <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. CL <br /> D�nn� dQ �� �- �. a o <br /> ...................... ......................... .............I............................ 2 .............................. ................................. <br /> OWN (please pri 1 CO RACTOR or SU RVEV OR or AGENT m <br /> ....1. mac:. L .1... . . . . a..i.. I.�� 3 <br /> F. ..... . . ..... ...... .... .. h.. .... .. ........ <br /> ADDLE SS ADDRESS — <br /> RE <br /> ....... m <br /> ......:...... . ..... ...................... y�� ................................................ <br /> ADDS ADDR2 -D <br /> i ?C^. <br /> ........... <br /> ........................................................................................... ... ..... ... .. <br /> . ............................................................... <br /> PHONE PHONE.. .. <br /> ........................................................................................... .W..EL.....L D......R.I.... ...............................................................I....... :� <br /> PLUMBER LLER.. <br /> O <br /> ........................................................................................... ............................................................................................ _. <br /> ADDRESS ADDRESS 0 <br /> 0 o <br /> ........................................................................................... ............................................................................................ :Z N <br /> PHONE PHONE ' <br /> DESCRIPTIONr <br /> 4. Sanitary Facilities: ° o ° <br /> 1. Work: No. Bathrooms ' <br /> 2. New Building Details <br /> 0 <br /> New Building „......„ Type of Construction: No. Bedrooms .......... <br /> addition ........ . .................................................... Septic Tank Size Gals. .......... <br /> Sanitary ......... Size ft. x ft. •• •• <br /> Pilling/Grading ,,,,,,,,,, Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... <br /> Soil Type ................... <br /> .......... ........................................... ................... <br /> Mobile Home Slope ............................ .... ... or <br /> .. <br /> Privy .......... 3. Use (describe exactly, i -family Pere. Rate ................................... i <br /> Well .. ,.. home,garage, motel, etc.) Dry Well .......... <br /> Subdivision , Seepage a e Trench .......... I i <br /> Camping Unit .......... PfIVy .......... <br /> • Seepage Bed .......... .(h <br /> ------------------------------- , <br /> Location of proposed structures and existing structures, well, sewage systems, roads, eta, should he sketched in Fig- A- Include road :M <br /> Q <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway infer- "� a <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING pI <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. Mt N <br /> p <br /> --------------------------------------- _ [ .� <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. . ............................... sq. ft. ............................................................................... i <br /> d <br /> o <br /> N <br /> o. <br /> E <br /> CSO) <br /> o <br /> of <br /> � s <br /> 1 � <br /> 1 T <br /> m <br /> O <br /> 3J <br /> a <br /> Co - 7 :E W m <br /> cr < �_ C <br /> (fl n f <br /> Z 00' � y n m <br /> 0 �0 am 3 <br /> Tim0 <br /> Signature of Owner or Agent Date ° C <br /> X <br /> Remarksm <br /> ......................................................................................................................................................................... <br /> T <br /> .............................. .............................................................. <br /> la <br /> .. <br /> .................................................................. <br /> Inspection Date ....................................... .. !!lL .�J... .... :nc.� �.................... Q ! N o N o m <br /> .. ................... . V '� <br /> Zoning Admi 1 rator ti <br /> f <br /> NOTE: A preliminary site inspection must be made an 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 hulld- <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 he made without approval of the Zoning Administrator . <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />