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4)"76aao <br /> Burnett County Office of Zoning Administrator �' c <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 andj- <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the ,� c <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and `a <br /> reg j�tions oft Stateof Wiscon n. » <br /> . ..5 Sr..H...> ....... ...................... ............ . . . . <br /> ..................................................................... <br /> 6;iNER((pleMPrin.t) CONTRACTOR � � a <br /> or SURVEYOR or AGENT <br /> N s,� 6 .. ..b��e / . ............................................................................................ a <br /> .. ........ ... ............. .. ...... ... ........ .. ...................... o, <br /> ADDRESS ADDRESS ,� 1 <br /> a..n. ...4.�s. � ...... ..►.. ........ ............................................................................................ <br /> ADDRESS ADDRESS ff � <br /> :v1 : 1 <br /> ............................... ........................................................... ............................................................................................ .� <br /> PH ' ............................................................... PHONE <br /> . . . ..................................................................................... <br /> OOff'11\\��EE <br /> PLUMBER WELL DRILLER <br /> O <br /> .............. <br /> . . . ................................................................................ . ..... .............................................................. n p <br /> ADDRESS ADD.. RESS........ m 0 <br /> o <br /> ........................................................................................... .*'H.0. .......................................... ....................................... =. <br /> PHONE PHON..E Z <br /> DESCRIPTION 4. SanitaryFacilities: ° o °» � <br /> 1. Work: 2. New Building Details No. Bathrooms .......... c 1 <br /> New Building .......... Type of Constr1lc ' n: No. Bedrooms .......... <br /> Addition Se tic Tank Size Gals. .......... <br /> Sanitary ....... Size .............. ft. x ............0. ft. }��d/n97an <br /> y�^ <br /> Filling/GradingrT 4a. Absorption Field Site: ' <br /> Height............. Stories ............... i <br /> Moving .......... Area ............. . .. ........................ Soil Type .................................... r <br /> Mobile Home Slope .......................................... .w <br /> Perc. Rate ................................... m ;r1 <br /> Privy .......... 3. Use (describeexactly, 1 -family 0 ' <br /> Well home,garage, motel,etc.) Dry Well 2 _ <br /> Seepage Trench o <br /> Subdivision """"" :of <br /> Camping Unit .......... .................................................... Privy .......... .Ci . L4 <br /> Seepage Bed .......... 1�)o i <br /> ------------ --- ---------------- <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is located at <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersection. ci, <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. :I T 0• ,�. <br /> _______________________________________________________________ <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. . ............................... sq.ft. ............................................................................... wt <br /> O <br /> N O <br /> O rr 7 <br /> ^y ; o <br /> � [ f <br /> 1, J <br /> ' 7 <br /> n m 0 <br /> Z <br /> a <br /> ua <br /> m <br /> N c N m n W Co <br /> o r^a < � on - -. m <br /> m Na�< � nm nag <br /> O iRO � "3 D� 3 <br /> N O in <br /> o _ a <br /> o c � m <br /> on : O <br /> c <br /> ,�aF. .. �....... x <br /> . ..... ................. ................................. /// : A <br /> Sign cure of caner or Agent Date e <br /> T: N <br /> Remarks <br /> w <br /> ........................................................................................................... .................. .. ..................................................... <br /> n _ " T <br /> Inspection Date ....................................... ('?14.. n o o m <br /> Pe Zoning Admini <br /> rat <br /> 5"�' 8 8 8 8 CA <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities before construction <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 been 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 APPROVED. <br />