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Burnett County Office of Zoning Administratorr o 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 i= <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 m <br /> a <br /> . <br /> OL. . ..E............ <br /> S.wLU....................... . .......................................................................................... H o <br /> c <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a _. <br /> n <br /> .........jet....I..............ell........./ol.r�s�>............. ............................................................................................ <br /> ADDRESS ADDRESS <br /> `......�>1.��.5........ Q. .......................................................................................... 0 <br /> ADDRESS ADDRESS /n <br /> LL''//��pp <br /> PHONE..............7.4s.'A... ..Q`. 0... .............................. . ................................................................................ <br /> PHONE <br /> u 1�� <br /> ........................................................................................... . 1 <br /> . ..........LLER........................................................................... <br /> PLUMBER WELL DRI <br /> ........................................................................................... <br /> A', D,ADDRESS . .......................................................................................... O <br /> SS <br /> n p <br /> PHONE . .PHONE.. .... ... . ................................................................................ �Z <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details ....����•� <br /> ... Type o Construction: ....r✓..•• <br /> New Building ,f No. Bedrooms o° <br /> Addition ,,,......, ,,,•, ! ni1tE:1'C9I?••••�,O•rV 'RETEgU Septic Size Gals. <br /> �y .......... i <br /> Sanitary .......... Size .... ...0.... ft. x ....> ...... ft. .......... . <br /> FillinglGrading .......... Height............. Stories .... 4a. Absorption Field Site: iv <br /> Moving .......... Area Soil Type .................................... <br /> • o <br /> Mobile Home .. ....... Slope ............................ ............. -+ <br /> Privy ......„•. 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Well .......... home,garage, motel, etc.) Dry Well <br /> Subdivision ......... ....I.,, „�4.Y.......Gt � Seepage Trench .......... �fv/ <br /> Camping Unit ,,,,,,,,,, Privy .......... <br /> .................................................. <br /> --- <br /> ------ ----- -------------------- — <br /> 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- .� a <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 /> at <br /> _____________________ _________________________ ------ c <br /> 5.to�7[ Size: / 7 Fig_A. 6. Location:'{ <br /> .9.:.al. ft. x f.�),�,Oe�D.Jft. . ............................... sq. ft. ' <br /> ............................................................................... <br /> 0 <br /> rn <br /> n <br /> n <br /> N 0 <br /> o <br /> 3 <br /> S <br /> O_ <br /> 4Dehej I o <br /> l <br /> 9-J m <br /> u <br /> 0 <br /> � � N <br /> C .9 < y � <br /> n tA� a � m � f <br /> m a <br /> m N d m m O < <br /> Z ca 0 n <br /> fA <br /> O <br /> O <br /> 1� m <br /> Signa rtG e Of net or Agent ( ) Date / `° C <br /> Remarks .`t�......_?.C'�...n!. !�.M....1.�-�rnt. ...A.JI .Q.7 7 X <br /> ....................................................................... o <br /> ........................................................................................................................................................................................ <br /> ....................................................................................................... .. ........................... <br /> u <br /> U` T <br /> Inspection Date ............. . .. . U 'o <br /> ........ .. nn MM <br /> Zoning Admini ra or <br /> NOTE: A preliminary site inspection must be made an a e approval granted on all structures involving Sanitary facilitius <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 bLJIId <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 Administratoi . <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />