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Burnett County Office of Zoning Administrator L' - - 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT -' 3 <br /> o :\ <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as '- N- " ;v <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 <br /> r ........ h ............................................................................................ � <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT •\ , i <br /> CL <br /> ..........G.�. ....1. .d.tlt... ....�t�tti :................. ............................................................................................ � <br /> ADDRESS ADDRESS ;e, •4 � <br /> ."i( (c ... ..a�.,y<.... . .0.3............. ............................................................................................ <br /> ADDRESS q ADDRESS <br /> ................. l:.. .. �. .../.��..0.,.......................... ............................................................................................ tyJ <br /> PHONE PHONE \ ~4 <br /> PLUMBER............................................................................ . DRI L <br /> WEL LLE..R........ <br /> ....... <br /> ...... <br /> ...... <br /> ......... <br /> ....... <br /> .... <br /> .................... s1 g <br /> ........................................................................................... ............................................................................................ <br /> ADDRESS ADDRESS <br /> n o <br /> ........................................................................................... ............................................................................................ <br /> PHONE PHONE Z o <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details .•••�••••• � o <br /> New BuildingT No. Bedrooms a <br /> .......... ype of Construction: ..•• ••••• : 7 n <br /> Addition Septic Tank Size Gals. .......... 3 <br /> Sanitary .......... Size ft. x ft. e <br /> Fillingf Grading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area Soil T <br /> Mobile Home .......... Slope .................................I........ 0 o <br /> Privy .......... 3. Use (describe exactly, 1 -family PerC. Rate ................................... <br /> Well .......... home,garage, motel, etc.) Dry Well .......... p <br /> Subdivision <br /> Seepage Trench .......... 'JI <br /> :Iv <br /> .......... .........................I.......................... <br /> Camping Unit ...XX... Privy .......... r ;. <br /> .................................................... Seepage Bed .......... N :� <br /> ad <br /> Location of proposed structures and existing structures well sewage systems, roads etc., should be sketched in Fig A. Include road vv C <br /> o Q <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 /> yt <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. p' <br /> ----------------------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: :T <br /> ..0L?..... ft. x ....,{ 0�..... ft. - ...... �OOI> sq.ft. ............................................................................... i,p ` ?� <br /> f..................' � <br /> P <br /> p6 n <br /> Application for land use camping permit from s —OS to •o o' <br /> n <br /> a <br /> 0 <br /> 9 <br /> � Z <br /> o <br /> 0 <br /> G <br /> M N r v :ECr <br /> y a <br /> m <br /> Z oo n <br /> o <br /> ..... o f7 <br /> Signature of Owner or Agent Date <br /> l <br /> Remarks-.1t '.'{i✓t ../CGCY Lf. i.J/..1.. D.. .. {k .r.' est T..G-...:7yf............................................................ . : �O <br /> m <br /> 6e <br /> ........................................................................................................................................................................................ ll 7 <br /> .............................................................................................. <br /> Inspection Date ....................................... ................. . ............... . . . <br /> Zor, Ad ........................................................... <br /> . . 880088 , - <br /> NOTE: A urchin inary 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 />