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Burnett County Office of Zoning Administrator T o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> O <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as 0 <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use <br /> Ordinance, SanitationJ.Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 0- <br /> r.1.........f�..........�I ................ .......1r1 .SpJC ................................................................ H <br /> OWNER (please print) CONTR CTOR o.r..SURVEYOR or AGENT a •l� <br /> ......... ..1. 7............................... . . ...... . ............................................................................... <br /> ADDRESS ADDRESS » <br /> ....................................... ............................................................................................ <br /> ADDRESS ADDRESS <br /> ....................A6...-... <br /> 7 ......................................... ............................................................................................ <br /> PHONE PHONE <br /> ........................................................................................... LL DRI. .LLER. . ...................................................................... <br /> PLUMBER WE <br /> . ............................................................................ O <br /> ADDRESS ADDRESS n o <br /> ........................................................................................... ............................................................................................ o ,» <br /> PHONE PHONE Z H r <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° 'v\ <br /> 1. Work: 2. New Building Details No. Bathrooms .......... o <br /> New Building ........,, pe of C ns ruc lop: p No. Bedrooms .......... <br /> Addition .., ,,,, ,p;tQ!✓,g-,, .�u.�,..G/D, (1,TVY.kkF- Septic Tank Size Gals. .......... ; ' - <br /> Sanitary .......... Size ...).. ..... ft. x .....'i..... ft. .......... <br /> Pilling/Grading .......... Height..k...... Stories ../............ 4a. Absorption Field Site: ? iS <br /> ............... 17- <br /> .......... <br /> Moving Area S;frV'A. ..... . .✓..0a., Soil Type ..................... <br /> Mobile Home U Slope .......................................... o <br /> .......... <br /> :CCA <br /> ! <br /> Privy .......... 3. Use (describe exactly, 1 -family <br /> Perc. Rate ................................... t <br /> Well .......... home, arage, motel, et Dry Well .......... <br /> Subdivision $ Seepage Trench .......... ; ;� <br /> ...�-h.�A2rw .....Q015 V11— q <br /> --Camping Unit— Privy .......... <br /> .......... .................................................... <br /> Seepage Bed ......... <br /> -------------------------------------------- W i iCn <br /> c <br /> Location of proposed structures and existing structures,well,sewage systems, roads,etc., should be sketched in Fig. A. Include road � Q <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 o `- <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o' <br /> ---------------------------------------------------------------------- <br /> 4 C <br /> 5. Lot Ize: Fig. A. 6. Location: c <br /> :M <br /> .�..... .t..l ft. x .............. ft. — ............................... sq.ft. ............................................................................... <br /> � 11 m <br /> 011�tMy » <br /> o 0 <br /> 3 0 <br /> 0 <br /> _. <br /> t-- 2,� J o <br /> I <br /> t I = N3a 'n m Q�f�a <br /> m : m <br /> Z �0 : a <br /> �s <br /> Jr ----- o -nth Vf _ .�T ........� .... �P ..... m <br /> Signature of Owner <br /> /,o��r Agen`f Date Remarks, .../ ........................`.s..95 0 T m� <br /> m : <br /> to <br /> .............................................................................................................................................................................I.......... — <br /> :\ n <br /> C : <br /> .. i m <br /> .tJrtC..J/ CCC a�L[_................................. 1 uNi a o �°ii o r�i� m <br /> InspectionDate ....................................... .G............................:.............9. . .................... ; ` : 0 0 0 o m <br /> Zoning Admin strator ,r J 8 8 0 0 0 0 N <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 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 /> 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 />