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r <br /> BurnetiCounty Office of Zoning Administrator d 0 0 <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 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 r <br /> Ordinance, Sanitation Code, and with all other applicable County`Ordinances <br /> /and the laws and regulations of the State of Wisconsin. 3 <br /> '.i!L�'f'✓................................... " /�CPi../v,�v".:...7t............................I.................. <br /> NER IPIease SURVEYOR or AGENT <br /> URV <br /> print)......................................................I...... T,RACRACTO)R p{SEa i'v <br /> GT . R Gtr- E m � <br /> ADDRESS ADDRESS <br /> �GJc t� ...&) S`/rx3 <br /> .............�. .............. N <br /> ADDRESS ADDRESS <br /> ........................................................................................... .PH....ONE..*N-E................................................................................ <br /> PHONE <br /> ........................................................................................... .WE.....L...L...DRI.E I'L'LER......................................................................... .o U\ <br /> PLUMBER <br /> .........:................................................................................. ............................................................................................ _' .,,,CCC <br /> ADDRESS ADDRESS m o - <br /> c <br /> . ............... o <br /> ........................................................................................... ........................................................................... . <br /> PHONE PHONE Z = <br /> DESCRIPTION 4. Sanitary Facilities: P o ° <br /> 1. Work: 2. New Building Details No. Bathrooms .......... o <br /> New Building ,.,,.,,,., Type of Construction: No. Bedrooms .......... <br /> Addition .......... .................................................... Septic Tank Size Gals. .......... �I <br /> Sanitary ,......... Size .............. ft. x ft. """"" <br /> FIIlinglGrading ........ Height............. Stories ............... 4a. Absorption Field Site: <br /> SoilType .................................... r <br /> Moving .......... Area ........................................... Sop <br /> Mobile Home .......... Slope .......................................... ^ <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ............................I...... <br /> Well .,....... home,garage, motel, etc.) Dry Well .......... <br /> . <br /> Subdivision ✓ Seepage Trench .......... <br /> Camping Unit .......... .................................................... Privy .......... <br /> Seepage Bed .......... <br /> N <br /> Location of proposed structures and existing structures, well, sewage systems, roads, eta, should be sketched In Fig. A. Include road Q <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 a <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS r o <br /> ---------------------------------------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... sq. ft. ............................................................................... <br /> �122 �--° V) <br /> 00 <br /> Nr o <br /> IO <br /> f�lti lll� � <br /> z L <br /> o <br /> m <br /> _ <br /> vimZ <br /> m <br /> nQ < m 2 �' <br /> m N F <br /> a _ n m <br /> oN: C ; eam <br /> 0 00 n ' 77 <br /> o <br /> i m <br /> ... ................... o C <br /> Signature of Owner or Agent Date <br /> X <br /> T <br /> Remarks ......................................................................................................................................................................... m m;Ry � <br /> m <br /> ........................................................................................................................................................................................ II <br /> t <br /> ............................................................................................................ '.� <br /> Inspection Date ....................................... .. +GO <br /> ��i <br /> U N oTZonntU `• Ir. g 8 8 0 0 o N <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 inform anon conveyed here- <br /> with is found to exist. Changes in plans or specifications shall not lie made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />