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Burnett County Office of Zoning Administrator o z J <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 J <br /> r4 <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as <br /> shown her, Sanitation Coder;and applicable County Ordinances and <br /> the requirements of the Burnett County Land Use m c <br /> n. The undersigned agrees that all work shall be done In accordance w <br /> Ordinance,nee, pp the laws and regulations of the State of Wisconsin 3 <br /> S,57 Ir <br /> ..... ......................................................... <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT m <br /> ........................................................................................... <br /> . .......................................................................................... <br /> ADDRESS ADDRESS i <br /> ................xi T/......................................................................................................... .ADDRESS............................................................................ <br /> V <br /> PHONE ..................................... . ............................................................................................ <br /> PHONE...... ....... ... ....... <br /> ..X57................................... .......................................................................................... <br /> PLUMBER WELL DRILLER <br /> .......................-.-............................................................. p <br /> ADDRESS ......................................................................................... ° <br /> c;� �0 <br /> ADDRESS <br /> 0 o <br /> . . .................................................................... PHONE . ..................................................... o <br /> PHONE <br /> DESCRIPTIONo r <br /> 4. SanitaryFacilities: o 0 V <br /> 1. Work: No. Bathrooms f\ <br /> 2. New Building Details •�������� <br /> o <br /> New Building ..• . ,,,. Type of Constr ction: No. Bedrooms ' ,✓ <br /> Addition ...X.... ......F/Q(t.(rT Septic Tank Size Gals. .... ..... <br /> . ................... .. <br /> Sanitary .......... Size ..... ft. x ...P.'�..2... ft. ... ...... <br /> Pu)ing(Grading ........., Height............. Stories ...../........ 4a. Absorption Field Site: <br /> Moving ........ . Area Soil Type .................................... � r <br /> ......................................... C^ o <br /> Mobile Home ........ . Slope ............................ ............. <br /> Privy ,.,....... 3. Use (describe exactly, 1 -family Perc. Rate ................................... e\ <br /> Well .,........ home,garage, motel, etc.) Dry Well .......... �9 <br /> Subdivision Seepage Trench .......... <br /> .......... ..J./......... .................�../.�............ <br /> Camping Unit ,,,,,.,,, W/J,�/ls.�.'.!!f.F'Y..!. . Privy ,,........ <br /> . .......... Seepage Bed .......... �� y <br /> ------------------------------------ -------- <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc, should be sketched in Fig. A. Include road e iM <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property Is located at a highway inter- t a <br /> section, show the intersecting highways and trip setbacks required along them and at the intersection. CLEARLY LABEL EXISTING 5 <br /> STRUCTURFS AND PROPOSED STRUCTURES AND ADDITIONS. <br /> ----_.--__-----------------------------------------------------------'--- <br /> 5. Lot Size: Fig. A. 6. Location: <br /> 0 <br /> 3. 0.... ft. x0.c,.. ft. — ....... sq.ft. ..............U.. W .....Iew.:d.S,i............. <br /> ist <br /> cO <br /> IN <br /> €u <br /> fi <br /> 0 <br /> T W <br /> u` SEPrr <br /> y z <br /> 0 <br /> d <br /> 2 <br /> / <br /> cis _ n oa <br /> J� a cn <_ C . < m c v <br /> a � <br /> o v't' a 3 <br /> � . ° <br /> n ..... .. .. ... ...... .1...... .... ....165 <br /> p <br /> Signature of O...w''erner'or Aggee'nn' .... .... ... . .. <br /> t Date � C <br /> X <br /> Remarks .n m <br /> ........................................................................................................................................................................................ <br /> ............................................ <br /> Inspection Date ....................................... � iJ U u o' c°1„ N m <br /> .. .. ...... o <br /> Zoning AdmIstr <br /> l ator 0 8 Vml <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary faculties <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must Lc 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 speclficationS 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 />