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Gf 7' L-C'?' . <br /> Burnett County Office of Zoning Administrator 0 o 0 <br /> APPLICATION FOR SANITARY -- LAND USE — BUILDING PERMIT d 3 <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as '� H <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 C. <br /> LSA.v.:.d......... .:......L... .. ................. .....Sql......................................................................... o <br /> OW R (please print) _ CONTRACTOR or SURVEYOR or AGENT a � <br /> .o.. ..e......y..........il... . ................... ............................................................................................ � L <br /> All KESS, ADDRESS <br /> ADRv.P/..`.. ..N..1.f.s..........w..l........ 0 3-. ............................................................................ <br /> ESS ADDRESS <br /> `1.1..5.. ... .a1.s...-.....7.0.................................... ... ........................................................................................ r ^ <br /> PHONE PHONE :W <br /> .......... <br /> ........................................................................................... . . . ..L...OR...I LLER................................................................... <br /> .......... <br /> PLUMBER WEL -�- <br /> ........................................................................................... . .. .......................................................................... <br /> ADDRESS ADD... ..RESS io 0 :n r <br /> ........................................................................................... . ............................. .. <br /> .. ...................................................... o' <br /> PHONE PH....ONE Z H r <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms o <br /> New Building ,,,. . Ty/pp�e o)af Construction: No. BedroomsJ� <br /> Addition ...X„. - .-D, ”""""" ... I Septic Tank Size Gals. .......... <br /> ft <br /> Sanitary ,,,,,,,,,, Size .... ft x . ... ......... """"" <br /> .......... Height Stories <br /> Filling/Grading g 4a. Absorption Field Site: <br /> ...g........ . <br /> Moving .......... Area Soil Type .................................... r- <br /> 0 <br /> Mobile Home .......... Slope ...................... <br /> .................... <br /> * <br /> Privy ,,........ 3. Use (describe exactly, 1 -family Pend. Rate ................................... i <br /> Well ....,,,,,, bre,garage, motel, etc.) Dry Well .......... <br /> Subdivision (� Seepage Trench .......... <br /> .......... .....0..kn�... . .....1..�.kl.t..!�... <br /> Camping Unit .......... ...... tt'ni.... Privy .......... <br /> yq� � �� Seepage Bed <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- O o- <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. - a <br /> ----------------------------------------------------._--_---------___—_ <br /> 5. Lot Size: Fig. A. 6. Location: l-7 <br /> ................ ft. x .............. ft. — ............................... sq. ft. ............................................................................... <br /> o <br /> J <br /> -A <br /> T <br /> is <br /> is <br /> O <br /> JJ <br /> N <br /> J <br /> m <br /> a <br /> S (N rm m RI Z <br /> C d d c N <br /> n Ise B F <br /> c n <br /> � a C to m <br /> Z O O m D a m <br /> o J a <br /> �rr ' <br /> o <br /> �. <br /> p <br /> f� �. ................. .....Y.... r .. 7. �.. . p <br /> Signature of Owner or Agent Date — <br /> X <br /> Remarks ......................................................................................................................................................................... m m <br /> � O <br /> ......................................................................................................... .... r ........ <br /> '� N N N <br /> Inspection Date ....................................... .. ..!7Va-.... ... pp......r�. <br /> ............... <br /> U u, o r. <br /> ZoningYAd rT i�trator�)'Y� $ $ ' $ U. <br /> NOTE: A preliminary site inspection must be made and sl e approval granted on all suctu res - volviny sanital-V faclliie <br /> s <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 Administratol . <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />