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Burnett County of Zoning Administrator C _ o f— <br /> Office <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 located as y \0 s� <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m c \ mil" <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. a 3 <br /> ...............S.Q..6.51 .7".e:R ............................... ........ .... ... .... ...... ............................. y o <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a CD <br /> b........... 1... ..ty............s.t........ ............................................................................................ <br /> ADDRESS ADDRESS <br /> 1I1. A. �...............: .t... .�r.. <br /> ADDRESS ADDRESS <br /> ........................................................................................... ............................................................................................ <br /> PHONE PHONE <br /> ..... -.`l'..3..y.z..................... <br /> PLUMBER WELL DRILLER <br /> .......... <br /> ..................................................... AD <br /> ............ .........SS...................................................................... <br /> ADDRESS DRE <br /> h o �l <br /> PHONE. ... .... ............... ... ............................................... ............................................................................................ 0 <br /> PHONE <br /> DESCRIPTION17, <br /> Z y 0 <br /> 4. Sanitary Facilities: o °° <br /> 1. Work: 2. New Building Details No. Bathrooms <br /> o <br /> New Building .... Type of Construction: No. Bedrooms .......... -CD <br /> o c�{ <br /> Addition ,•, .................................................... Septic Tank Size Gals. .......... <br /> Sanitary .......... Size .......�.2, ft. x .... ft. .......... <br /> Filling Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving Area Soil Type .................................... r c <br /> .......................................... o <br /> Grading ..... Slope .......................................... <br /> Mobile Home .... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Privy .•.... home,garage, motel, etc.) Dry Well ......... <br /> Well Seepage Trench <br /> .. ..�.. Q.0 . ..�. ....... C��C t <br /> Subdivision Privy .......... <br /> ... ............................................... <br /> Seepage Bed ..... .... <br /> -------------------------------------------------- ------------ 0 <br /> Location of proposed structures and existing structures,well,sewage systems,roads,etc.,should be sketched in Fig. A. Include road �V <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- o <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. �fv o <br /> ---------------------------------------------------------------------- <br /> 5. Lot Size: �y Fig. A. 6. Location: <br /> l...P...P. ft. x ..�..A.Z( ft. — ............................... sq.ft. ............................................................................... <br /> C <br /> o <br /> v :(4 <br /> h <br /> -- -- 0 <br /> �l7 � <br /> jai w <br /> CD <br /> •ci <br /> 0 <br /> 1L' to <br /> CD <br /> U) <br /> C 0) CD <br /> C CD <br /> d <br /> oc: m <br /> O <br /> ;O <br /> 3 CD. ... .. .... ......... .... . .... .. .. .............. ..............--.................... o <br /> gna re of Owner or Ag Date C <br /> X 70 <br /> Re rks � !!� `.S!9. „ E m <br /> ..... ....... <br /> CD <br /> CD <br /> ........................................................................................................................................................................................ <br /> u <br /> ........................................................................................................................................................................................ <br /> Inspection Date Gk1z�t�R„ .�1. ::.kcft�'.* : 0 o 0 0 0 o cNn m <br /> ....................................... <br /> f...................... ej: 000000m <br /> Zoning Administrator o 0 0 0 0 o cn <br /> VOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> )efore construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> his application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build- <br /> ng until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> vith 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 />