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Burnett County Office of Zoning Administrator d -0o 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 �� <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 a O <br /> 1 <br /> �afi! f <br /> 1. ....r....:.s............................h.:............................... ................ . ...................................................... = <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT o. M <br /> ADDRESS...... <br /> .1. .................................................................. DESS <br /> .ADR ............................................................................ <br /> M <br /> .. )DR S.S............................................................................ <br /> ADDRESADDRESS AJ <br /> :n <br /> ................................................................................. <br /> PHONE � PHONE <br /> �U uCY <br /> ............. ,W........`. ..................................................�S v . . . . ........................................................................ <br /> PLUMBFJi _� _ WELL DRILLER � V <br /> ...(. .''.......... �..G..�...5./.! <br /> .......................................... ...................................................................,........................ '� O <br /> .......................... . . <br /> ADDRESS ADDRESS `' n' 0 <br /> : . �. .�...r. `�.'......... ...y 8� <br /> ........................... ............................................................................................ <br /> ..... O .. <br /> PHONE PHONE Z J <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> 1. Work: 2 No. Bathrooms New Building Details "•':: <br /> New Building ,,,,....,, Type of Construction: No. Bedrooms .......... qJ <br /> Addition •..••..... ... Septic Tank Size Gals. :1.5..o <br /> i <br /> Sanitary Size .............. ft. x ............., ft. .......... pig <br /> . <br /> Filling iGrading .......... Height............. Stories ............... 4a. Absorption Field Site: i <br /> Soil Type ..................... .............. :j: <br /> Moving .......... Area ........................................... �B-,� o <br /> MobileHome Slope ........................ .............. <br /> .......... R <br /> Privy ••••,,.... 3. Use (describe exactly, 1 -family Perc. Rate ............../................... <br /> Well ........., home,garage, motel, etc.) <br /> Dry Well .......... 'n— <br /> Subdivision .......... <br /> Subdivision .......... Seepage Trench .......... r <br /> .................................................... <br /> Camping Unit Privy ......— NZ ' <br /> ..'. Seepage Bed ....`." . , <br /> ---------------------------------------------------------------------- R1 m <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., 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 <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o <br /> ---------------------------------------------------------------------- J <br /> 5. Lot Size: Fig. A. 6. Location: , <br /> ................ ft. x .............. ft. — ............................... s4.ft. <br /> m <br /> N ppp p <br /> O :µ 7 <br /> J 4'Ya� <br /> l7 Vv <br /> O0 <br /> S <br /> O <br /> Z <br /> O <br /> m <br /> J <br /> m <br /> ]7 N r U W Em Z <br /> C <br /> m d n - n £ <br /> o1 < C o <br /> bH: ^ ' yam <br /> Z <br /> oo n � 31 <br /> o J n n 3 <br /> fA a – _ <br /> Signature Of Owner or Agent Date — <br /> Remarks . ....... .. . ..... ................................................................................................................................ m <br /> .........../.Y.Y.....K{r:v�rG. ...Z'( Ett ¢................................................................................................................. <br /> `ff (�(�� II <br /> ............................. <br /> ................................................... .. ............ :A <br /> p...... .................. ... .... ..... <br /> 7 �/ / <br /> Inspection Date . ... ..:......(... .:...... ........ �.......:.... i <br /> Zoning Ad nistrator `t'J 8 8 8 8 8 8 y <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 be made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />