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County Office of Zoning Administrator d M1 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> o <br /> DO THE ZONING ADMINIgTRATOR'. The undersigned hereby makes application for a Permit fcr the work described and loc ted 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 i ,— <br /> Ordinance, Sanitation Cade, and with all other applicable County Ordinances and the laws and regulations of the State of Wis opsin. <br /> o <br /> u�t� ....... .................................................................................. ......... - <br /> Y <br /> N <br /> WNEE (please print) CONTRACTOR or SURVEYOR or AGENTclu <br /> r `D <br /> . -.... o..G. .�..... .............................. ` <br /> ............................................................................................ a <br /> ADDRESS ADDRESS °Q <br /> �.: <br /> . <br /> ST.: !,?.!�.� ......./�Z. '.:....5'5..... 5 ................. <br /> ARE .. ... ... .. .. ... ............................................................... .......... <br /> SS ADDRESS ._ <br /> ?.zl.-.S'.6.... 5`..... ................................................................................. .......... <br /> PHONE PHONE <br /> ........................................................................................... <br /> PLUMBER WELL DRILLER <br /> ADDRESS ADDRESS n o <br /> ............... . . ............................................................... . ................................................................................. .......... Si <br /> PHONE PHONE Z <br /> DESCRIPTION 4. Sanitary Facilities: <br /> 1. Work: No. Bathrooms ... <br /> 2. New Building Details """' !1 <br /> New BuildingType of Construction: No. Bedrooms ... :. <br /> Septic Tank Size Gals. .��. <br /> a .......... Hee ht..Y... Stories „.i.:?.'ft. <br /> Filling/Grading <br /> 4a. Absorption Field Site: <br /> 1.......... :� <br /> SoilType ......................... .......... r <br /> Moving .......... Area ......................................... ° <br /> Mobile Home SOPS ............................... .......... _ i_-. , <br /> .......... i <br /> Privy .,?.�.... 3. Use (describe exactly 1 -family Perc. Rate ................................... i— <br /> Well .......... home,garage, motel, a Dry Well .......... r -�_ [ <br /> Seepage Trench r� <br /> Subdivision .......... ......... ............ .......... ��i r�.. <br /> Camping Unit Privy .......... <br /> ----P-9 p! 'L.IJ............................ <br /> ------------------------------------------- Seepage Bed-------- --- — i 3 <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. nclu e road <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway Inter- <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLFARLY LABEL EX STING i k, <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. ,( <br /> :r J <br /> --------- ----------------------- <br /> - ---------------------------------------- --- <br /> 5. Lot Size: + .-��— �- Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — sq. ft. <br /> �. <br /> N I O <br /> O J <br /> J <br /> y O <br /> 9 <br /> m <br /> �. p <br /> �_ 7J <br /> C.^ J <br /> t0 <br /> ' v\ <br /> f� <br /> C <br /> M tnr- v � mmz <br /> c m d c m <br /> al <br /> to < C < m c Z <br /> Z C) nn3 <br /> O J o m <br /> — = <br /> 01 0 — <br /> . .... .. ti. ........ z 5...��.......: _ C <br /> Jo <br /> Signature of Owner or Agent e Date <br /> i... / / X n <br /> Remarks .. .... ° ... ...... . .. rlI - � ............ .......... ........................................... ..... . . . <br /> C <br /> ........ ........... ......................... ..... ...... ... ........ ...... ..... ...... ... .... ... ..... . .. ... <br /> 11 <br /> i. <br /> Inspection Date ....................................... r.... ... :. .... .. :...... "I u, o v, o v. R <br /> Zoning Administrator <br /> i <br /> NOTE: A preliminary site inspection must be made and 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 percolatl n test must be, attached to <br /> this application before a permit will be issued. Do not purchase or install a septic tank, do any p umbing or start any build- <br /> ing until a permit has been issued. A permit may be revoked if misrepresentation of any of the I formation conveyed here- <br /> with is found to exist. Changes in plans or specifications shall not to made without approval of the Zoning Adm inisHatoi. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFF IC AND APPROVED. <br />