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Burnett County Office of Zoning Adminis atom/ 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and loc ited as < <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Lad Use m <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> ..Ml.Q�. .4... ........ Q.F. :e.. ............................ ... <br /> c O <br /> ............................. . . . . .......................................... ......... m <br /> OWNER (pl se pri CONTRACTOR or SURVEYOR or AGENT <br /> y �- G <br /> 1.V .b.s ' .r........w.l........s'Y�i.. ............. .................................................................................. ......... <br /> AD SS ADDRESS <br /> ..t.. ....I.4�.D........................................... .................................................................................. ......... .� <br /> ADDRESS ADDRESS <br /> ........................................................................................... ....... .................................................................................... <br /> PHONE PHONE v1 i i <br /> R.. oda. to s...................................................... ............................................................................................ <br /> PLUMBER WELL DRILLER <br /> ........................................................................................... <br /> ADDRESS ADDRESS <br /> n o ro <br /> PHONE PHONE Z h <br /> r- <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° !� <br /> 1. Work: 2. New Building Details No. Bathrooms ....... o <br /> New Building .......... Type of Consty lop: No. Bedrooms .......... <br /> Addition ..., ,.,,, $ �h Septic Tank Size Gals. .......... p� <br /> ....... ..........................CC u <br /> tl.......... ..... .. ..... <br /> Sanitary ...>' '- Size .............. ft. x .............. ft. .LytS��a <br /> Filling/Grading ......, Height........... Stories ............... <br /> 4a. Absorption veld Site: i <br /> Moving Soil Type ................................ <br /> .......... ........................................... <br /> Slope ............................... <br /> Mobile Home ..•.•.• *� <br /> .......... <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ........................ .......... :I : <br /> Well ........ home,garage, motel, etc.) Dry Well .......... <br /> Subdivision ,,,,,,,.,, Seepage Trench .......... .y.�, <br /> .................................................... t� <br /> -- — — — -- — — — -- <br /> Camping Unit .......... Privy ,.p........ <br /> Seepage Bed <br /> ]]]CCC111 i� i <br /> -- -- — — -- — ------ -----,---- <br /> N <br /> Location of proposed structures and existing structures, well, sewage systems,roads, eta, should be sketched In Fig. A. Inclu e road � 7•}� <br /> setback, side and back - y <br /> yard dimension and location and setback from all bodies of water. If property is located at a hlghwa inter- o- <br /> section, show the intersecting highways and the setbacks required along them and at the Intersection_ CLEARLY LABEL EXI 3TING <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. _I-- No <br /> kc <br /> --------------------.____—_____—___-----__------------------------- ---- T <br /> 5. Lot Size: Fig. A. 6. Location: ,�! i I <br /> ................ ft. x .............. ft. . ............................... sq.ft. .................................................................... ......... Xl <br /> I <br /> Q, <br /> ' o ° <br /> o <br /> 0 <br /> t1 � <br /> or So / bdo t z <br /> a16� <br /> 3 <br /> SV v4 / Sw! IGS✓ I�r 14 m <br /> p c m <br /> atNii 2a' C . <br /> cm <br /> Z 0 6 0 l D 37 <br /> a m <br /> o no" <br /> o <br /> 0 <br /> m <br /> .... . ..... . . . ............... ....................... ...................................... p <br /> Signature of Ow/ or�Agent Date - <br /> Remarks Lel.... C� `� x M <br /> IZF.... .......... m m <br /> 9 ...... ....... <br /> �v _ <br /> ...........LCA '.".�"'............................. .. .................................................. <br /> .................................................................................................. ..... .................... ........ <br /> Inspection Date .�/...:..1�..." !�'.......... ... . .. � .. „� N Sm^ . SN" 'MM <br /> Zoning Admirxtrator $ 0 0 0 o y <br /> NOTE: A preliminary site inspection must be made and site approval granted on all s,ructures irvolving sanitary facilities <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolatioi test must be attached to <br /> this application before a permit will be issued. Do not purchase or Install a septic tank, do any I)IL robing or start any build- <br /> ing until a permit has been issued. A permit may be revoked if misrepresentation of any of the in ormation conveyed here <br /> with is found to exist. Changes in plans or specifications shall not be made without approval of tic Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />