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Burnett County Office of Zoning Administ for �' c <br /> APPLICATICrN FOR SANITARY - LAND USE - BUILDING PERMIT 3 �� <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work describe and '� <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements f the <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the law and 3 iQ <br /> reg u let ions of the State of Wisconsin. a <br /> ............... ................................................................................... ....... A <br /> OWNER (pleasepRnt) CONTRACTOR or SURVEYOR or AGENT <br /> t.l...... ...C3.7............................................ ................................................................................... ........ d <br /> ADD ESS ADDRESS + :-}\ <br /> ... ,,,r,an; ,HuNq...f.. .�.1. . .. x. ................. ................................................................................... ........ 3 ✓V . <br /> ADDRESS J / ADDRESS <br /> / —...6... .` .-.. .3.. .... ............................. <br /> ff . . .. . 7 <br /> PHONEIRR <br /> ..................................................................... PHONE <br /> . . . ... .... ............... ................. .............. ........... .......... .......... ........WE LL DRILLER <br /> 0 <br /> ........................................................................................... . . ...... . ...................................................................... ........ <br /> ADDRESS ADDRESS m L'f <br /> n o <br /> ........................................................................................... . . ....................................................................... ........ o <br /> PHONE PH....ONE.... .. Z <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms ..... c i <br /> New Building-6-RZ(.W; ..\L.... Type of Construction: No. Bedrooms . ........ <br /> Addition �, ,f , f, ,e..,-••• Septic Tank Size Gals. . ........ <br /> .......... ...........GG '+� r.............. <br /> Sanitary Size ..f�.s. ft. x ..-..{.�lcz., ft. . ........ <br /> .......... <br /> Filling/Grading .......... Height.... .1../^� Stories .0............. 4a. Absorption Field Site: <br /> g .....�.L1J... r'..F..T....... Soil Type ........................... ........ i '• r— <br /> Moving ,,,,,,,,,, Area <br /> o <br /> Mobile Home .......... Slope ................................. ........ <br /> Privy .......... 3. Use (describe -family Perc. Rate .......................... ........ m <br /> � <br /> Well .......... home,garage,motel, etc.) Dry Well . ........ <br /> Seepage Trench Z <br /> Subdivision .......... ..� . . .. ..}. ........ . ........ o <br /> f/ ... <br /> Camping Unit . ....�-.1 ........... Privy . .I...... .L <br /> Seepage Bed <br /> . ....... <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in F g. A. <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is loce led at FL <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the interse(tion. <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o <br /> -------------------- ---------------------- -- <br /> 5. Lot Size: Fig. A. 6. Location: —1— , <br /> ................ ft. x .............. ft. . ............................... sq. ft. ..................................................................... ......... <br /> 1 <br /> n <br /> N O <br /> O O <br /> A f-bCbecl ')ra_'o, rf`, <br /> 0 <br /> 0 <br /> D� <br /> m <br /> Z <br /> O <br /> A <br /> d <br /> M <br /> M <br /> nna < 05 oe. am <br /> m. 6n — nm nay <br /> v < . m c "2 > > 3 <br /> N `Z N p n 1 <br /> Zoo . ';2 D -4 <br /> o n y <br /> 0 <br /> a 2 : O <br /> m <br /> � D <br /> .. .... .......... .................. ......... <br /> x <br /> n : m <br /> Signature of Owner o Agenn Dae ' G <br /> g : <br /> T: N <br /> Remarks ...... ...... .. ............... .................. ............................................................ ...... M �- : . <br /> ��Iy � <br /> ........ ...................... .... . <br /> ...... .........�:z: �.. .L <br /> ................. ................ .... ... ............................................................ ...... <br /> ........I.......................... . . .................. . ............................. g <br /> Inspection Date ....................................... <br /> TMOning Admini tr for � g g g <br /> NOTE: A preliminary site inspection must be made and site ap roval granted on all structures involving sanitary f cilities before constru <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 be n 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 AF PROVED. <br />