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`0 <br /> Burnett County Office of Zoning Administrator 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT - 3 <br /> d <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as <br /> Use <br /> in <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m ?� <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin_ 3 n <br /> �I.o.r!zH.S........ /......}� T�.�£.So.�tJ............ ........ ..O.f�..� . ....f5./t.R.7�..e .................... _ <br /> n O <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a <br /> '...T.... <br /> .........8.O..X....al................................. ...........R.T ......%........... ..o.. ou <br /> X.....a... �' <br /> �..................... <br /> ADDRESS t ADDRESS <br /> ..........w...1..5c ...........P..fi. .ry.. ..R.k.o.o...K..........w..t. s c- J1 <br /> .......................... .................. :Q <br /> ADDRESS ADDRESS \� <br /> s ..-..7a..�.. ........................................... ............... . .:-. ...y..3.. ...................................... <br /> PHONE PHONE <br /> ........................................................................................... .WELL DRILL............ IL'L.E..R..................................................................... O <br /> PLUMBER iU� r <br /> r. . . . . ... . ... .... . .......................... ............................................................................................ <br /> . ........ .. . ... . .... ...... ... ... . <br /> ADDRESS ADDRESS n o <br /> 0 < <br /> o' <br /> PHONE PHONE Z <br /> DESCRIPTION 4. Sanitary Facilities: ) // ° o ° 1/, <br /> .L....l.oZ- .° <br /> 1. Work: \; 2. New BuildingNo. Bathrooms <br /> Details o <br /> New Building .,,....... Ty pgg of Construction: No. Bedrooms ...3.... <br /> Addition .,...,,.,, ......4..0�.t$.N 7 Septic Tank Size Gals. ...� <br /> Sanitary ......,... Size ..pl...MJ.. ft. x .wP.�}}.... ft. <br /> Fiuingf Grading .......... Height.,3o........ Stories ...(..frZ.. 4a. Absorption Field Site:\ ' I <br /> Soil Type ......S.is.;), .............. r <br /> Moving .......... Area ....\............................... o <br /> Mobile Home ....... Slope .......................................... ,} ^ <br /> .......... I , <br /> Privy ,......... 3. Use (describe exactly, -famil Perc. Rate ................................... <br /> Well .......... home, g5age, motel, etc.) Dry Well .......... (r <br /> subdivision / Seepage Trench .......... <br /> .......... ...../. . . . <br /> Camping Unit Privy _r <br /> .......... ........ .................�......................... Seepage Bed <br /> --------- ----------------------------------------------------- r'J or, r < <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc_, should be sketched in Fig. A. Include road 1�� (}j a r <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. <br /> -------------------------------------- — --------- <br /> 5. Lot Size: ._ Fig. A. 6. Locatio <br /> / rw StU <br /> ................ ft. x .............. ft. — ..................4�r.C11..R�sq. ft. ...�'�.,�1Jp../..1...........'...S,.w................... x <br /> m <br /> N o' <br /> o <br /> RiVeR KoR1� cotALI <br /> 0 <br /> o <br /> � t � <br /> p <br /> vS <br /> Z <br /> O <br /> d <br /> m <br /> i\l <br /> V <br /> M Vlmv men <br /> U s Nd ¢ � d ¢ CO <br /> .0 <br /> O m n <br /> O o y n <br /> n v TI O O ¢ 3 <br /> C o . -1 <br /> N <br /> m <br /> p <br /> Signature of Owne or Agent �1 Date / X 70 <br /> Remarks ....... . / GU . /.............�to..... <br /> t <br /> II <br /> ........................................................................................................... .-.-...I.,.,.../.././..... y..../............ .................................. : T <br /> Inspection Date ....................................... [+!/GV.F...:......(...'CC? ./..J............. N o o m o rH., m <br /> m m <br /> $ <br /> Zoning Admi Istrator 8 g 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 shall not Ifa made without approval of the Zoning Adm inistratoi . <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />