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-0-7-7, C:�' _ <br /> Burnett County Office of Zoning Administrator o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 :\ <br /> o :3.� <br /> TO THE ZONING ADMINISTRATOR'. The undersigned hereby makes application for a Permit for the work described and located as < 7 .W <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m :� <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 aVy <br /> ...�.f. ................................................ . . . . . . . .................................................... <br /> ON :f1 7 <br /> WNER (please print) CONTRACTOR or SURVEYOR or AGENT 0 i® <br /> �� - ............................................................................................ n <br /> ..1.4DRES ....!.�:�....!�....r............................................ <br /> ADDRESS ADDRESS <br /> Qra.�.lYl..k ......! .............. 7?.y........... . .......................................................................................... = <br /> ADDRESS ADDRESS r <br /> :n <br /> ........................................................ ............................................................................................ <br /> PHO E PHONE <br /> _- <br /> .....Y.z.....l.l.ay//�.. ��.s........................................................ ............................................................................................ � :lN <br /> PLUMBER I WELL DRILLER <br /> ro :F <br /> ........................................................................................... ...........R ................................................................................. <br /> ADDRESS ADDESS <br /> n o <br /> ........................................................................................... .......N–E................................................................................ 0 ,» <br /> PHONE PHONE <br /> DESCRIPTION j 4. Sanitary Facilities: �y ° o ° <br /> 1. Work: .V/j No. Bathrooms ....R.... <br /> 2. New Building Details g , i.t o <br /> ' <br /> New Building Type of Co struction: No. Bedrooms *.. <br /> Addition ............... <br /> ion Septic Tank Size Gals. .... ..... : .» <br /> . ...:K ... W <br /> Q:JN .................. .� i < <br /> Sanitary '� • <br /> .......... Size .. ...... ft. x .. 4....... ft. �• <br /> FillingiGrading ,..,.•,.,, Height.....`...... Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area Soil Type .................................... o �o <br /> Mobile Home Slope .......................................... 3 <br /> Pere. Rate ................................... <br /> Privy / 3. Use (describe exactly 1 -family F <br /> Well .,,y,.,, home, garage, motel, etc. Dry Well .......... <br /> Subdivision ,,,,,,,,,, Seepage Trench .......... � <br /> Camping Unit .......... Privy ..... . a <br /> .......................I............................ t4 <br /> Seepage Bed <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc-, should Inc sketched In Fig. A. Include road t .4 � <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property Is located at a highway inter- 0- <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING tom) <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. I o' <br /> --------------------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: 2 <br /> ................ ft. x .............. ft. — �Cr r�....... sq.ft. ....................................... <br /> N <br /> 0 <br /> N � :,uo <br /> 4 <br /> a <br /> I � 4 o <br /> �. i P <br /> >jci I (, a4 ISO --�f i -o <br /> �feX4 :771 <br /> 41 `` •• 'L <br /> T N T <br /> L <br /> Z <br /> O <br /> JJ <br /> d <br /> m <br /> M N r m m <br /> taO O ¢ JA <br /> O 0 n m <br /> d\� : 3 <br /> .. .. - .............. ..... ..b..-... 6. c <br /> Signature of Owner or Agent - o <br /> r� 1 ... � x <br /> \/rt �1 . .t.. ...f... .... .... m m <br /> Remarks ........................ � .. .�. ��.�.�.............................................................. � <br /> I <br /> II <br /> ............................................................................................................. ... .....4o,'ni <br /> .............................................. :gyp . . . . . <br /> Inspection Date ....................................... ..... �.?"'�'_ ,r 1°i D u o i'n o u m <br /> g Administrator 8 8 8 8 8 8 0 <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures intiolving 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 buildl <br /> - <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 />