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Burnett CoutSty Office of Zoning Adm, �' o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3• <br /> C T <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws no 3 <br /> re ulations of the State <br /> J/ooff Wisconsin. o- <br /> vu.y. .��..........l.'.:e. .................................... <br /> . . . . . . . ................................................................. ...... s <br /> . . . ...... . . . . <br /> OW�N7ER (please print) CONTRACTOR or SURVEYOR or AGENT •. <br /> E-: s...................... ................................................................ ... a i <br /> .... ........................................... .................. ... ... ar i <br /> ADDRESS t ADDRESS � <br /> ,.r. b�. ....t..ul. ........ �© .......................................................................... ...... - <br /> ....................... <br /> ADDRESS ADDRESS <br /> 7. ...-Q'7o S <br /> ............. ...... <br /> a, <br /> PHONE PHONE , <br /> ............................. . .................................... ..................................................................................... ...... <br /> PLUMBER WELL DRILLER <br /> Ws I" ..... . . . . . c 's S <br /> ADDRES ADDRESS c <br /> ( .`�t� ............................................ ..... . . . S <br /> ..................................................•••..................... ...... a <br /> PHONE PHONE Z r A <br /> DESCRIPTION 4. Sanitary Facilities: 0 0 0 <br /> 1. Work: No. Bathrooms .... v <br /> 2. New Building Details " " n c i '• <br /> Now Building .......... Type of Construction: No. Bedrooms .. ...... <br /> Septi jarl)c ize Gals. .. ....... ;J <br /> Addition .................................................... l6`I Vim( _ < <br /> Sanitary ..�..... Size .............. ft. x .............. ft. S <br /> Fillip /Gradin 4a. Absorption Field ite: <br /> Filling/Grading .......... Height............. Stories ............... I ?^' <br /> Soil Type ....................Moving .......... Area ................................... .... . ...... •C r i <br /> Mobile Home Slope .................................. ....... 71 ;'O .. <br /> Privy .......... 3. Y5p4describe exactly -famil Perc. Rate ........................... ....... <br /> 1. <br /> Well .......... hom garage,motel, et . Dry Well .... z <br /> Subdivision ... <br /> Seepage Trench .. ....... p '• <br /> Privy .... <br /> _—Camping Unit <br /> ------____.—__------ _�------------------------ -- I]1 i <br /> Seepage Bed .... - al' <br /> c <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fil I. A. : $J :O <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is local ad at <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersection. <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o <br /> C <br /> J <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. . ............................... sq.ft. V' <br /> 1-7r i�- A-GYPS O >� <br /> p <br /> N <br /> J S <br /> 0 <br /> z <br /> N <br /> Z <br /> O <br /> 3 � J <br /> M � <br /> M mvmr > mtn -0 <br /> m c m m p c c <br /> m <br /> yc p tp �p <br /> OlA O_ .G D <br /> D n M <br /> ?� r: . . . . . ........................................ .? .:.. .J::..`: ....... v <br /> Signature of Owner or Agent Date c <br /> T N <br /> Remarks <br /> 6 N <br /> .................................................................................................................................................................................. ..... <br /> O <br /> ].............�.... .... .. .. ..................................................................................................... <br /> Inspection Date ....................................... ° <br /> M <br /> .... m <br /> Zoning Administratorl <br /> - S 88 S S S y <br /> NOTE: A preliminary site inspection must be made and site appy"oval granted on all structures involving sanitary fa ilities before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this application before a permit will <br /> be issued. Do not purchase or install a septic tank, do any plumbing or start any building until a permit has bee i issued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or specifications shall not be <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND AP ROVED. <br />