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Burnett County Office of Zoning Administrator d o Y <br /> Z <br /> 0 <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 <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use c <br /> Sanitation C�(o,�q and with <br /> all <br /> other applicable County Ordinances and the laws <br /> and regulations of the State of Wisconsin. 3 a iV <br /> OWNER. <br /> ease. ....�..../U'.L7ZC`......!:`' ice............................. /..i!utic.'�C!J....C•,:....( ....... ..................................... '^ O <br /> Ordinance, <br /> a <br /> print CO TRAC O or SU RVEVOR or ENT m <br /> CL <br /> ........................ / ....1�i........ :.yy3........................ <br /> ADDRESS ADDRESSf--� <br /> ADDRESS ADDRESS <br /> ........................................................................................... <br /> PHONE . .......................................................................................... r <br /> PHONE .� <br /> ........................................................................................... <br /> W <br /> PLUMBER . .ELL... . . .. <br /> D..R....LER......................................................................... <br /> IL � <br /> u <br /> ........................................................................... . .............................................................I..................I........ <br /> . o \ <br /> ADDRESS ADDRESS <br /> n o <br /> PHONE <br /> r <br /> DESCRIPTION4. Sanitary Facilities: ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms .......... <br /> 0 <br /> New Building .......... Type of Construction: No. Bedrooms .......... a <br /> addition .......... ...........................I........................ Septic Tank Size Gals. .......... <br /> Sanitary .......... Size .............. ft. x .............. ft. <br /> .......... < <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: i <br /> Moving .. ....... Area Soil Type .................................... <br /> ........................................... r <br /> Mobile Home .......... Slope .......................................... ° <br /> Privy .......,., 3. Use (describe exactly, 1 family Perc. Rate ................................... <br /> Well <br /> home,garage, motel, etc.) Dry Well .......... ) <br /> Subdivision <br /> ..// P 9...,.. See a e Trench ,.,....... <br /> .................................................... <br /> Camping Unit ,,,,,,,,,, Privy •�1' <br /> .................................................... <br /> .......... I r <br /> — ------------------ Seepage Bed .......... <br /> -- <br /> --------------- ` Us,Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig A. Include road <br /> setback, side and backyard dimension and location and setback from all bodies of water- If property Is located at a highway Inter- i a <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING (` 5 <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> o' <br /> ------------------------------------------------------------ <br /> -_________ <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ft. x .............. ft. . ............................... sq. ft. i <br /> ............................................................................... <br /> 0 <br /> 0 <br /> U �/ 0. <br /> o�� , l �yy lye W; <br /> O W <br /> 0 <br /> 0 <br /> F <br /> yy � <br /> ~J � <br /> O <br /> d <br /> m <br /> Mmr W W Z <br /> C c m <br /> m a <br /> - m <br /> Z o: > s <br /> o <br /> ....................................................... . . . m <br /> Signature of Owner or Agent Date ° C <br /> Remarks X <br /> .......:.................................................................:.............................................................................................. m <br /> ° 0 <br /> .................................................................................................................................................................................... <br /> ......................................................................................................... ............................................................................ (� <br /> Inspection Date ....................................... r�.?t!.rA.. ... � : 1° 1 N M <br /> �J <br /> c <br /> ......K................ i \3 0 0 o m <br /> Zoning Administrator . . g g g g g o H <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 percolation test must be attached to <br /> this application before a permit will be issued. Do riot 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 /> with 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 />