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:nett CountyOffice of Zoning Administrator --I <br /> 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3. <br /> o � <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as 7 �J <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use 1 v g$ <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a '`L1 <br /> ao..Y..N.......Q..:...NY....... ........................................................................ <br /> 0 <br /> . . . ...... . . . . <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a <br /> .%... i......4��ort.....a.(a...C7.... .. ............................................................................................ , <br /> ADDRESS ADDRESS m <br /> . . . . . . ............................................................................... <br /> ADDRESS r ADDRESS <br /> '..6. ..-. .y. ............................................... ............................................................................................ <br /> PHONE PHONE <br /> WE <br /> ........................................................................................... ............................................................................................ <br /> PLUMBER <br /> WELL DRILLER V� <br /> O <br /> ........................................................................................... ............................................................................................ —. <br /> ADDRESS ADDRESS 0 a <br /> < :R <br /> » <br /> ........... <br /> ............................................................................................ o .; <br /> PHONE PHONE Z H r G�0 <br /> DESCRIPTION 4. Sanitary Facilities: 0 o 0 _ <br /> No. Bathrooms <br /> v <br /> 1. Work: 2. New Building Details • '•v•,• c .p <br /> New Building Type of Contryuction: No. Bedrooms .......... W 9 <br /> 1�7vcv.f Septic Tank Size Gals. ....:..... i� <br /> Addition I X.......4... ........ p < <br /> Sanitary .........• Size .... ..� ft. x .... ... ft. •• ••• • • <br /> Filling/Grading .......... Height.... <br /> $7....... Stories ...... ....... 4a. Absorption Field Site: <br /> MovingArea .................................. ........ <br /> Soil Type .....................��..... •r <br /> .......... o <br /> SlopeMobile Home .......................................... <br /> Privy ...... 3. Use (describe exactly, 1 -family Perc. Rate .............................. <br /> !.�... V <br /> well .......... home,garage, motel, etc.) Dry Well ......i:.. <br /> Seepage Trench <br /> Subdivision .......... ...... ....................... Priv <br /> --Camping Unit— ..Q.Q.�'... . .. .... .11?... y ....y,... \ i <br /> . ......... . Seepage Bed ....... <br /> ....�,.. � <br /> ------------------------------------------------------------ <br /> Location of proposed structures and existing structures,well, sewage systems, roads, etc.,should be sketched in Fig. A. Include road i <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 /> ----------------------------------------------------------- i <br /> 5. Lot Size Fig. A. 6. Location: <br /> 40.0...... ft. x ..L7.1. ft. — ........4...................... sq. ft. <br /> L.�ke.wu� dvt�2 O (W <br /> 75W 0 <br /> ��-_�-- N i i, JJ� <br /> r y - <br /> aG4-T <br /> 114- »vv o <br /> a S aD / ul TQ ceei! �U <br /> I u� o <br /> Sill Itne <br /> iso <br /> < <br /> C� <br /> OO eJ4,ppw11-6lj o G <br /> m 70 <br /> b ; m <br /> p <br /> ........................................................................... ...................................... .) o C_ <br /> Signature of Owner or Agent Date <br /> X <br /> Remark ......................................................................................................................................................................... 0 <br /> °lA1t ...../. S.wec�.. e! ....T.�,Q .....Pa (�........9 !� ..... <br /> ..... ............................................... <br /> ............................................................................................................... ................ ... ........ .............................4....... . . . . .n <br /> Inspection Date ? G �e <br /> ....................................... ... . .... ......... 9 ........... . ^; u ,rs'nou o m <br /> b Zonin dministrator...................... i 8 8 8 8 8�rn <br /> � .. <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 We made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />