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Burnett County Office of Zoning Administrator d - 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 c <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 p- <br /> -�- p^ <br /> l.o>x...... ssr........................................................ ..... <br /> .............................................. _ o <br /> OWNER (please print) CONTRACTOR Sg.�R.V..E..Y...OR0or <br /> ..... <br /> V.IZ.....�lGrdti. ,nJ..MUCH <br /> ... . ...................................... . ....}r�s- ..................................... aa <br /> m <br /> ADDRESS ADDRESS <br /> ....... .......� 1............i ;.n...... ............................. ,. -......V. ......... °/.................................... <br /> ADDRESS ADS <br /> i 1 <br /> yB'�Yf................................................ .........I/,�..-.G3s..-..2S.o.L............................................... 00 F� <br /> PHONE PHONE <br /> ........... ..................... ✓ <br /> ....................................................... ............... ............................................................................ <br /> PLUMBER WELL DRILLER <br /> L. <br /> ADDRESS ✓ ADDRESS <br /> o <br /> PHONE PHONE <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details <br /> New BuildingNo. Bedrooms .. <br /> .... Type of Construction: <br /> Addition ,..,, .... ,... ¢ Septic Tank Size Gals. .... ..... <br /> 7; < <br /> Sanitary .......... Size ..Z-. .. ft. x ..Z.Y. ft. ...... L'+ <br /> Filling/Grading ,,,,,,,,,, Height 4... :r�. $t ries ...�........... 4a. Absorption Field Site: 3 i •� <br /> J <br /> Moving .......... Area ......� ....�....... Soil Type ............................... . . .< r <br /> Mobile Home Slope o <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ............................... ... <br /> Well ........., home, garage, motel, etc.) Dry Well ... .. i� i�•)�, ': <br /> Subdivision Z, 2 Seepage Trench <br /> W ..... .... <br /> ...... Wr:. . k r.......71.... .............. <br /> Camping Unit O Y .... ..... k <br /> ............. V................................. Priv i <br /> Seepage Bed .......... <br /> -------------------------------------------------------------------- <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc_, should be sketched in Fig. A. Include road ��)1 <br /> setback, side and back yard dimension and location and setback from all bodies of water_ I1 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. L7. <br /> --------------------- ---------------------------- -------------- O <br /> 5. Lot Size: i+ 0 <br /> uu�/ Fig. A. 6. Location: y s <br /> ................ ft. x .............. ft. — ...L/ ............... sq.ft. ........f-.S:rsa:r.......IV........................................... <r . <br /> p <br /> c <br /> pl_ i <br /> 13 <br /> "ol <br /> G , i J s <br /> Fr <br /> M z <br /> 6" t2o 64 <br /> t <br /> iG <br /> h 7,7 N r 9 to m Z <br /> � d n W <br /> � W am <br /> Z o 6 <br /> 0 � nom' <br /> O <br /> m <br /> ......... .. J +.....f zOvc'fc ......................... .... . ! /. <br /> Sig ure Owner or Agent Date .. _ <br /> X 717 <br /> Remarks ..................................................................................................... m m <br /> ........................................................................................................................................................................................ <br /> u <br /> .............................................................................................................. i. ..... .......... .... <br /> �1J <br /> Inspection Date ......... ..... ....... ..... .... ........ .-.1......Y� ��lf"r <br /> t <br /> m <br /> Zoning Administrator g o 0 0 oaf <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary faclhtirls <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 />