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Burnett County Office of Zoning Administrator i o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> o t* <br /> TO THE ZONING ADMv, 0INISTRATOR: 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 m c <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 <br /> _ m n O <br /> u........ ........... ...... .�t..!rn..l..�. ..?....... .....................'. .. e.... .......,.............................................. N <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT AD <br /> �. ! C CSP f. � r -FPn . ............................................................................ :rj <br /> .............. . <br /> ADDS.......... ........................ . ..................... <br /> ............. <br /> ADDRESS <br /> �f SS �..h..: S 1..0 l .......................................................................................... <br /> .. r <br /> (.�... ...T...ti............n? <br /> ADDRESS ADDRESS <br /> a.� <br /> Ec <br /> PHO N PHONE <br /> � <br /> 4 . nth S a <br /> ........... . .. <br /> .... ... ...................................................... ............................................................................................ g - <br /> PLUMBER WELL DRILLER K-W <br /> ........................................................................................... . ........................................................................................ N <br /> ADDRESS AD... DRESS :NZ, m <br /> . . .. . . . . , . . . .. ......... <br /> . . n n <br /> 0 <br /> ............. 0 <br /> HO4lE ............... ... .............. . .... ........... .. .......... —..... .P-H-O-N.E... ............ ........ ......—....... ...... ....... ........ Z < <br /> :Ll <br /> DESCRIPTION 4. Sanitary Facilities: o o 0 <br /> 1. Work: 2. New Building Details No. Bathrooms <br /> New BuildingT No. Bedrooms a`— �.E'fV o <br /> ........ ype�on truction: <br /> Addition Septic Tank Size Gals. <br /> , . . <br /> CJ <br /> ` < <br /> Sanitary ...?�.. Size ... . .... <br /> ft. x ... .... ..... ft. .........�;i <br /> Filling/Grading Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving ,,,,,,,,,, Area <br /> Soil T e .................................... O ' <br /> YP o <br /> Mobile Home Slope .......................................... t :.T <br /> Privy .......... 3. Use (describe exactly, 1 -family Pero. Rate ................................... :4 <br /> Well „ ... home,garage, motel, etc.) Dry Well .......... <br /> Subdivision Seepage Trench <br /> .......... . ... <br /> Camping Unit .......... Privy <br /> .................................................... <br /> Seepage Bed ....... <br /> --------------------------------------------------------------- - ---- <br /> ----------------------------------------------------------- --- ---- N <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. Include road :1 <br /> setback, side and backyard dimension and location and setback from all bodies of water. If property Is located at a highway inter- a <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING O <br /> v <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. p' <br /> --------------------------------------------------- ------------------ <br /> 5. Lot Sizq: �r Fig. A. 6. Location: <br /> .../.7....... ft. x ..�........... ft. — ............................... sq.ft. .............................................................................., <br /> a <br /> m <br /> n <br /> N o <br /> o � <br /> � W <br /> 0 <br /> k H <br /> t � <br /> mI L: T <br /> O <br /> 71 <br /> l CC' <br /> LLL x <br /> m <br /> < <br /> m w <br /> r <br /> L,: <br /> n m f <br /> Nd <br /> 'o rn <br /> < w : •c ro' E <br /> Z O p D 4 <br /> _ 3 <br /> 6 0 <br /> 0 <br /> Sign lure of Ovor gent Date I — <br /> X Sl <br /> Remarks ......................................................................................................................................................................... T m� � <br /> u <br /> ............................................................................................................ :O : . . . . . <br /> � N � m � Nm <br /> .. ............./..�..................................................... <br /> Inspection Date ....................................... .Q!hz[O/ �.,.. .... . . . ..........K ............... `°: o a o u o u, <br /> m <br /> Zoning Administrator ✓ $ 8 8 8 8 8 0 <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures Involving sanitary facllities <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must lie attached to <br /> this application before a permit will lie 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 tie made without approval of the Zoning Adm Inistrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECFED BY THIS OFFICE AND APPROVED. <br />