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Burnett County Office of Zoning Administrator c <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> - <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as u, ;W <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m .v <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> .. ............ J.!JZf��e ............... ............. %1 . ................................................................ c AP <br /> OWNER (please print) _ CONTRACTOR or SURVEYOR or AGENT C <br /> ..��✓......... .I//G'rt/.....�Re..... ............................................................................................ m <br /> N <br /> ADORE <br /> S // .. ADDRESS <br /> ......D.G<. �/ S/.��.1../.......(/N.:..✓�. .3•.3. ...... . . . . . ................................................................................. <br /> ADRE.�(SS/. ADDRESS <br /> PHONE............ ............................................................... .PHONE.... <br /> ............................ ............. .............................................................................. Q <br /> PLUMBE WELL DRILLER <br /> ........................................................................................... ...A.DD..... <br /> ..R ...ES.............................................................................. .� <br /> ADDRESS S n o <br /> ........................................................................................... ............................................................................................ o - <br /> PHONE PHONE � <br /> Z r <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> h <br /> Batrooms <br /> 1. Work: 2. New Building Details No. """"" i o <br /> New Building No. Bedrooms ' <br /> ,.. Type off�anstruction: """"" E � <br /> Addition �� Septic Tank Size Gals. .......... <br /> 7�rf.. a .... < <br /> Sanitary .......... Si ze ....P. .... ft. x ...9 .......... <br /> ........... .... <br /> .. ... ft. <br /> Filling)Grading .......... Height............. Stories ..../........ 4a. Absorption Field Site: <br /> Moving ......... Area ........................................... Soil Type .................................... <br /> ; � <br /> Slope .......................................... <br /> 3 0 <br /> Mobile Home <br /> PrivyPerc. Rate ................................... <br /> .......... 3. Use (describe exactly, 1 -family <br /> Well .......... home,garage, motel, etc.) Dry Well .......... A <br /> Subdivision ,,,,,,,.., Seepage Trench .......... it <br /> ............. <br /> Camping Unit .......... 6l.11. Privy o . <br /> f .......... <br /> ............. ......... ........................... Seepage Bed <br /> ------------------------ - --------------------------- <br /> Location <br /> —_ _--Location of proposed structures and existing structures,well, sewage systems, roads,etc., should be sketched in Fig. A. Include road 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- ✓ a <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING <br /> C a <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. ,s <br /> 5. Lot Siz Fig. A. 6. Location: , <br /> ....�a Y... ft. x .o�...I.. ft. — ............................... sq.ft. <br /> w <br /> 0 <br /> n <br /> 0 <br /> N O <br /> o � � <br /> O <br /> f <br /> S � <br /> ).J m <br /> Z <br /> 0 <br /> d <br /> m <br /> � rnr v mm <br /> C d < m C m <br /> -o <br /> fA a n - m a a E C m m <br /> m <br /> m — m <br /> Z oo a � 70 <br /> o n <br /> �. � c c <br /> ........ .. rv�............................. ........ . ...... . .................. o <br /> Sig t f Owner or Agent ate <br /> X S <br /> „ <br /> Remarks .......................................................................................................................................................... m <br /> ............... p <br /> m <br /> FA <br /> ...................................................................................................... ....................... . : : : : <br /> Inspection Date ....................................... G' /'.:.-............ .J........... N 8 at <br /> 8 8 8 8 8 8 vmi <br /> Zoning Admini rator <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, To 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 lie made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />