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Burne@t County Office of Zoning Administri for �' o <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 <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements ol the <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the Stateof Wisconsin. » n <br /> W hW. .. .. .. C041. S0 N <br /> ....... ...... <br /> OWNER (Please print) CONTRACTOR or SURVEYOR or AGENT <br /> � � ab lTnel� woac ..A <br /> .................... . ... ..!'I .'?-................. .................................................................................... ....... d � <br /> ... . ..................... <br /> ADBBRESS ADDRESS = <br /> I� f✓P <br /> ADDRESS . � ADDRESS..................... l........... .�.z.�::..... ........... ...................................................... ....... i Edt <br /> i <br /> :D'O <br /> PHO E................................................................................ .PHONE..................................................................... .... <br /> DQ <br /> "......................................................... .................................................................................... ....... °Q <br /> :O <br /> PLUMBER WELL DRILLER �• <br /> ........................................................................................... .A..DD.....R..ES'E'S"S..................................................................... ....... , <br /> ADDRESS C '� <br /> :e <br /> O .i <br /> ........................................................................................... .................................................................................... ....... <br /> PHONE PHONE Z N r :L <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> No. Bathrooms v <br /> 1. Work: 2. New Buildin Details "' 0 o i <br /> g <br /> New BuildingT No. Bedrooms `-- <br /> .......... Type of ConstruCtiyn: 7. .. .... . <br /> -t• Septic Tank Size Gals. S.?. '• <br /> Addition .......... .........m[....�1........"1�.............. � •7 <br /> Sanitary .J.. ..... Size .............. ft. x .............. ft. .. ....... <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: i <br /> Moving .......... Area ......................................... Soil Type .................................... o <br /> MobileHome Slope .......................................... r <br /> .......... <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate .......................... ........ <br /> m <br /> Well home,garage,motel, etc.) Dry Well Seepage Trench ..... o 'Y •`C <br /> Subdivision ........ ig. <br /> Camping Unit .......... .................................................... Privy <br /> Seepage Bed �. . sY <br /> ------------------------------------------------------------------- -- I i� -C i <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. ;y t <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is loca ed at P— <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersec ion. <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. :�• o <br /> ___________________________________________________________________ __ � J <br /> 5. Lot Size: Fig. A. 6. Location: <br /> a° <br /> ................ ft. x .............. ft. — ............................... sq.ft. ...................................................................... ........ t :� <br /> 0 <br /> N <br /> J o <br /> J E iUl <br /> o <br /> M ? <br /> M Y <br /> � d <br /> Z <br /> O HT1 <br /> A <br /> a <br /> J <br /> m <br /> Acwo a � J o - - m <br /> m Nn c nm ani <br /> a < w c o J J <br /> 8N : omm <br /> Z•O : ,2 D 1 <br /> o c m <br /> ...... ................... .............................. ...................................... <br /> Signature of ner or Agent Date o: o <br /> Remarks .C.!.1. . C6Tq•— <br /> ................... !./'.1P w.fCl...a.U.. ..-�6/r� �. .. /rr. /t{<�A../fnC.£.:L'.kZ.Y...e.......................I............. ...... qq. <br /> tl o <br /> �N N ' � Nm <br /> Inspection Date ./.. ../../...\ .!...� U�+.... ..M...... .. W!.84././�LVI.V ^p............ T T O O N m <br /> Zoning AdministQtator <�" Ijg $ o o $ f/1 <br /> NOTE: A preliminary site inspection must be made and site ap roval granted on all structures involving sanitary f cilities 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 bet n issued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans oi specifications shall not be <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE ANDA PROVED. <br />