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Burnett County Office of Zoning Administrator <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described nd <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 knd 3 `8 <br /> regulations of the State of Wisconsin. a <br /> OWNER prin CONTRACTOR or SURVEYOR or AGENT <br /> o. �.✓. .,�.:.. .t..✓. ... ................ ...... <br /> ADDRESS d m Q <br /> ADDRESS <br /> I /. <br /> ........... ..Y..7. ..1 . .�tulrw...14;�........................... . ................................................................................... ...... <br /> ADDRESS J ADDRESS ° °• <br /> 114M ...SSI..Z(............................... .PHONE......................................................................... ...... . <br /> .............................. <br /> .................................................................................. ...... o <br /> PLUMBE WELL DRILLER <br /> ........................................................................................... . ......... ....................................................................... ...... _. <br /> AOORESS A..ODR ES..S G <br /> O. . ........................................................................... ...... w <br /> PHONE P..H..ONE.. .. <br /> rj <br /> DESCRIPTION 4. Sanitary Facilities: P o <br /> 1. Work: 2. New Building Details No. Bathrooms c <br /> New Building ,...X., Type of str do No. Bed roo s A <br /> .. <br /> Addition ............... P,e - �• ,� Septic Tank 'ze Gals. .. <br /> ....... .. . ...... .. .. .......... <br /> Sanitary Size .....1.��.... ft. x ..... •• ft. •• <br /> .......... <br /> Filling/Grading .......... Height...... torles ....I 4a. Absorption Fie Site': <br /> Moving .......... Area / ...`, .a.rf..�... Soil Type ........... . ............... ...... i E r S <br /> .............. .. o <br /> MobileHomeSlope ............... ... ............... ...... n <br /> .......... <br /> Privy .......... 3. Use (describe exactly,'1 •family Perc. Rate .... ........ ............ ...... <br /> Well .......... homegarage, motel et Dry Well .......... i <br /> Subdivision (�.(-].G.....51,,..-./.-� ••.,_ Seepage Trench .. ....... o E <br /> .......... ..... <br /> Camping Unit Privy .. ....... <br /> Seepage Bed .. ...— '• <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. { n C <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is local d at <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersection.. _ <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. 0 <br /> ----------------------------------------------------------------------- <br /> 1 <br /> 5. Lot Size: Fig. A. 6. L cation: d ilk: <br /> .....��.!?S. ft. x . 4M.... ft. — ............................... sq.ft. ... . �.... ' :...... :(�J , <br /> �Rl�.li�1Xf.... '•. �tA}.t55.... u. <br /> N v O <br /> O (- <br /> to v <br /> lOev o <br /> UO <br /> 0 <br /> 0 <br /> gXZ0 <br /> jb/ler „ <br /> Z <br /> P <br /> S, <br /> ),rglle� <br /> e,fy,, y✓- N C N N 0 C C <br /> �/'�/ 1 1✓_ , c �a < > > o m <br /> Nr m. �a ay nn <br /> pro' ro"= <br /> n owo � D 1 <br /> /� ptJ fiJr "M . . y a : <br /> 0 . <br /> o <br /> M To <br /> lfl �� f............ O <br /> Signature of Owner r Agent D9te o <br /> y . <br /> Remarks ............................................................. a ' <br /> m •• <br /> v <br /> ........................................................................I.............................. ?al <br /> .............�....... ... .............................. .... T <br /> . I '7\ �'U. l � � o um <br /> Inspection Date ....................................... .. aYip/J.....I........................... ..fY�.......... .... m <br /> Zoning Administr or <br /> NOTE: A preliminary site inspection must be made and site appranted on all structures involving sanitary facilities before constrikiction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this appl cation 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 5pecifications shall not be <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND AP ROVED. <br />