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urnett County Office of Zoning Administrator a o r o <br /> APPLICATION FOR SANITARY = LAND USE — BUILDING PERMIT 3 <br /> -0 THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as _ o \ <br /> hewn herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m � V3 ^'V <br /> Jrdinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a IW <br /> Claris Bilotca , , , ,,,,,, , , , , N m <br /> .......................... ........ � <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a ^ ? <br /> 21 <br /> . <br /> 3•,Maple•,View....Ma21.eW.vaA.,...PQ ....S.5k.09 ........................................................................................... <br /> ADDRESS ADDRESS •* ;` <br /> ........................................................................................... .A........................................................................................... \ <br /> ADDRESS DDRESS <br /> ........... <br /> ........................................................................................... ................................................................................. <br /> PHONE PHONE ' <br /> A.an.a]d..A. tiis3.a...................................................... ............................................................................................ <br /> PLUMBER WELL DRILLER <br /> �. <br /> ...r.ax...w.....Sira.t.,...Fi1....5.4i.1.2................................. ............................................................................................ <br /> ADDRESS ADDRESS o <br /> .....4.6.3...233.3..or...3.49..536..4........................................ ................................................... ....................................... 0 0 0 <br /> o <br /> PHONE PHONE z <br /> DESCRIPTION 4. SanitaryFacilities: i� <br /> 1. Work: 2. New Building Details No. Bathrooms 7"" �, o ' <br /> New Building Type of Construction: No. Bedrooms .......... <br /> Septic Tank Size Gals. .......... 'r <br /> Addition .......... .................................................... .F � <br /> bsor i n ta:k 2000 , <br /> Sanitary ...X.... Size .............. ft. x .............. ft. .......... <br /> Filling ,......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area .............. Soil Type .................................... <br /> ........................ . <br /> Grading .......... . . . Slope .......................................... <br /> Mobile Home .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... :\ c <br /> Privy .......... home,garage, motel, etc.) Dry Well .......... <br /> Well .......... ......_.si:tlo..family............. Seepage Trench .......... <br /> Subdivision .......... Privy .......... i F <br /> .................................................... Seepage y, <br /> Bed .......... � <br /> Location of proposed structures and existing structures,well,sewage systems, roads,etc., should be sketched in Fig. A. Include road <br /> _a <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- ' <br /> section, show the Intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o <br /> ' <br /> --_-- \ <br /> J <br /> 5. Lot Size: Fig. A. <br /> ft. x . i t <br /> ............. ft. . ............................... sq.ft. <br /> i V1 <br /> M <br /> N (� o <br /> p \ J <br /> J <br /> 0 <br /> W ' <br /> 0 <br /> O <br /> Z <br /> O <br /> d <br /> J <br /> N <br /> 3 N r— no W <br /> m <br /> m <br /> 13 on , J <br /> oz <br /> o m <br /> alsc <br /> ..... . .... <br /> Signature of Owner or Agent Date X m <br /> Remarks ............................................................................................................................................................................ '^ i <br /> ........................................................................................................................................................................................... <br /> .....................................................................................................................'.................................`................................... <br /> i 1ovf <br /> InspectionDate ....................................... .................:..t�T............................................................ 0 0 b' o m <br /> Zoning Administrator 0 0 0 0 rn <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 shallnot be made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />