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(-I r (_ >- ro / ' <br /> Burnett County Office of Zoning Administrator C - o o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT h' 3 <br /> 0 4 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as v, * :� <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use CD c (� <br /> Ordinanc , Sanitation ode,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. I a ?�q <br /> _. <br /> eoz <br /> ...... ............................ ...T.... ... .............................. .............�.................... .. .................................................. y rF <br /> OWNER (please rant) CONTR CTOR r URVEYOR or AGENT �\ <br /> �....... CD <br /> o..... ✓! l� .7�.... !✓............. '�T....L� ........... Q �cn <br /> .............................. <br /> ADDRESS ADDRES <br /> ............................... <br /> !a f........ ............................... 2.. ....... ....A!V� ............�-� .. ... ..... .............................. <br /> ............Cv �Y� <br /> ADDRESSADDRESS <br /> 0........... .........- ..�'...... .......... ......................... ............................................................................................ <br /> v <br /> : <br /> PHONE P ONE :` v <br /> ......................................................................................... <br /> PLUMBER WELL DRILLER <br /> ADDRESS ADDRESS � <br /> 0 a< <br /> ........................................................................ .. <br /> PHONE ............................................................................. o' <br /> PHONE <br /> z DESCRIPTION 0 r <br /> 4. Sanitary Facilities: ° o ° <br /> 1. Work: No. Bathrooms 0 <br /> 2. New Building Details o <br /> New Building Typ Const uction: <br /> No. Bedrooms -0 <br /> Addition � Septic Tank Size Gals. .......... a <br /> .... .. <br /> Sanitary .......... Siz ...... . r ft. x .. .. ft. .......... <br /> Filling Height..l . .... S ories ::.: 4a. Absorption Field Site: y <br /> Moving �. y <br /> Soil Type ...................................• S� <br /> Area ....... ` Yp 0 <br /> Grading Slope .................................... ..... <br /> Mobile Home 3. Use (describe exactly, 1 -family Perc. Rate ........................... ....... \ <br /> Privy .......... home,garage, motel,etc.) Dry Well .......... ill <br /> Well Seepage Trench .......... '• <br /> .......... <br /> Subdivision Privy .......... <br /> .......... ...................... ............................. <br /> Seepage Bed .......... 1� <br /> ------------------------------------------------------------ j <br /> Cn <br /> Location of proposed structures and existing structures,well,sewage systems, roads,etc.,should be sketched in F——————————ig. A. Include 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- a <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. `— <br /> ------------- ------------------- <br /> ---------------------- :� 3 <br /> 5. Lcit Size: Fig. A. 6. Locat'on: <br /> �?... �rJ O — .... .3 ZC7....... sq.ft. C <br /> ... ft. x / .......ft. �1f•:..�� P-....`:�1. .................... ...... C <br /> O <br /> e e 0 <br /> 0 <br /> (� z Q) <br /> P� <br /> XCD <br /> � <br /> (' z <br /> = d �. CD CD <br /> m Naas <br /> cn < <br /> e M <br /> 0 CD 70 <br /> o M <br /> ........... . ..... " �...3 p <br /> ...9 . .. <br /> Signature of Owner�or Agent Da E' ° C <br /> Remarks (/GG�e..e��-e?� -t CD <br /> ........................................................................................................................................................................................ — <br /> ............................................^........................................................... ............ ................................ <br /> :c c <br /> Inspection Date - :�,? m <br /> :01 <br /> 00:..9 ..... ................. om <br /> Zonin Administrato 0 0 0 o V) <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> aefore 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 build- <br /> ing 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 />