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Burnett County Office of Zoning Administrator d o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 0 <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as < 5 * ;� <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m o <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. D a i <br /> l�l.L..... ..r..G.�........... �.1./�.�... .s..Q.. ............................................................................................ C o <br /> OWN R (please rind ` \ CONTRACTOR or SURVEYOR or AGENT a <br /> 'N <br /> ADDRESS � .....� �� � ADDRESS .........../ r'... .................... VIN Z� <br /> :. 2e�c� �7it :p <br /> ................................. <br /> ...................................................•........ ...!........a.3.'::rte%. si ....... . .... ..T/. <br /> ADDRESS ADDRESS <br /> PH E P ONE <br /> ....... <br /> a i, j .. . ....................................................................... ` U <br /> PLU BER � WELL DRILLER [� <br /> O <br /> .......................................................................................... ............................................................................................ :U —. <br /> ADDRESS ADDRESS <br /> s O 0 o :r(' <br /> ........... lip <br /> ................................................................................ <br /> 1. ...� o..................................... Z <br /> PHONE PHONE 1 \ <br /> DESCRIPTION 4. Sa itar Facilities: ° o ° <br /> h <br /> Batrooms <br /> 1. Work: 2. New Building Details No. '••'•"'•' <br /> N <br /> New Building No. Bedrooms .......... = O <br /> ........., Type of Construction: ao <br /> i <br /> m <br /> Addition .......... .••...., ...... Septic Tank Size Gals. .......... `a < <br /> Sanitary ... Size .............. ft. x .............. ft. .......... \I <br /> '.� <br /> Fin4a. Absorption Field Site: <br /> inglGrading ,,,,,,..,, Height............. Stories ............... E <br /> Moving Soil Type .................................... r <br /> .......... Area ........................... ............... � o <br /> Mobile HomeSlope .......................................... <br /> .......... <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Well home,garage, motel, etc.) Dry Well <br /> Subdivision .......... .................................................... Seepage Trench .......... <br /> Camping Unit Privy .......... S <br /> Seepage Bed .......... 41 <br /> Location of proposed structures and existing structures, well, sewage systems, roads, eta, should be sketched in Fig. A. Include road <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 t <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o <br /> __________ ___________________________________________________ . <br /> 5. Lot Size: Fig. A. 6. Location: <br /> v <br /> ................ ft. x .............. ft. . ............................... sq. ft. ............................................................................... <br /> IN <br /> z <�. <br /> 3 <br /> C] <br /> 0 <br /> Z <br /> a <br /> ek <br /> M M r to m z <br /> c <br /> m <br /> (fl a a <br /> to on � '9 <br /> 0 : m <br /> Z oo n M <br /> o — Z am 3 <br /> A - <br /> � o _ 1 <br /> 7— .. . <br /> :`elm C <br /> o <br /> 5,g,a <br /> ....... ......... . .................I........ .. . ... ... ........... . o Cture of Owner or t Date <br /> X �1 <br /> Remarks ......................................................................................................................................................................... r m <br /> al i O <br /> ............................................................................................................................................ <br /> ........................................................................................................... . . ....................9...... . ................ ................ <br /> o: <br /> H <br /> N c�'no $ oam <br /> Inspection Date ....................................... ..�lY.lf.^�. .. .............. ........... ................ 0 . m <br /> Zonin Admini rator 'eJ 8 8 0 0 0 lA <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 most 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 he made Without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />