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Burnett County Office of Zoning Administrator Iv' 7311 <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 '2 M <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 d <br /> regulations of the State of Wisconsin. <br /> I"i'✓.�lkl.... <br /> m <br /> �IU..IQH. s '.(✓ <br /> E rid <br /> ....... .. . . ....... ........................... .............................. ............................................................................................ m <br /> OWN R(p(lease print) C CONTRACTOR or SURVEYOR or AGENT at <br /> 1�T........1......... ............................................... ............................................................................................ d .7 <br /> ADDRES ADDRESS <br /> H b vy7 <br /> .......(.Jl. ..................... : 5� 93 <br /> . . ............ .... .... ............. ............................................................................................ <br /> ADDRESS ADDRESS �T— <br /> L.S........... 6.. ...-...7..,?35�..�........,.. <br /> PHONE 8�(0 _ y3g'3 PA,/ PHONE <br /> ........................................................................................... <br /> PLUMBER . .......................................................................................... <br /> WELL DRILLER <br /> O <br /> ADDRESS ADDRESS <br /> 0 o <br /> ........................................................................................... . . .PHONE. .................................................................................... .Z N <br /> PHONE � � <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details i o i <br /> New,Building .......... Type of Construction: No. Bedrooms .......... <br /> R E <br /> Addition .......... ........pne.......a.rti ...... Septic Tank Size Gals. .......... :L <br /> 1..... ft. .......... <br /> Sanitaryi� <br /> .......... Size ...5.Ca... ft. x ..'� :. <br /> Filling/Grading .......... Height....�Z... Stories ............ .. 4a. Absorption Field Site: <br /> Moving .......... Area ........................................... Soil Type .................................... r <br /> o <br /> Mobile Home .......... Slope .......................................... ^ <br /> Privy .......... 3. Use (describe exactly,'1 -family Perc. Rate ................................... <br /> n <br /> well .......... home,garage, motel, etc.) Dry Well .......... i <br /> Subdivision ..•.•..... Seepage Trench z <br /> Camping Unit ......... Privy .......... . <br /> Seepage Bed <br /> -------------------------------------------------------------- . <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. C <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is located at A-h <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersection. `— <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. a' <br /> -------------------- _ _----------_-------_----------_ <br /> 5. Lot Size: Fig. A. 6. Location: :C <br /> L................ ft. x .............. ft. — ............................... sq.ft. ...... ........................................................................ <br /> N Jj:JerS���} �l <br /> Lame <br /> N O <br /> t o <br /> -pblh lis[ <br /> r)� o J i <br /> /70Z " 0 <br /> r o <br /> r <br /> I <br /> a <br /> Z t� <br /> �a <br /> m <br /> x` <br /> C <br /> V Nr D co a) -0 <br /> < > > o `-- - m <br /> m Nn•c � nm an A <br /> ,z m '0 m' 3 <br /> O5.N O O <br /> » e : s <br /> i <br /> ...... ..K/Yf!... . . �Agnt <br /> .. ...... m <br /> Signature of Owner or e - D to <br /> 0 <br /> T: <br /> N <br /> w <br /> a <br /> ............................................................................................................ ... 8 8 <br /> Inspection Date ....................................... ......... . uN, o u, T <br /> Zonin Administrat r �jy� 8 8 8 8 8 <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this application before a permit will <br /> be issued. Do not purchase or install a septic tank,do any plumbing or start any building until a permit has been issued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or specifications shall not be <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />