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� . <br /> Burnett County Office of Zoning Administri for fC ig <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. 3 <br /> uj <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and M s, l <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements o the <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the/State of Wiscc .T— g <br /> L.IJ.O .Q:aS..T..Xl.1.YJQ.0........ .�.��..l.l..Q.n............... ..................................................................................... ...... n <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT <br /> . d ....6a.k.�5.:.. ..............`.................................. .................................................................................... ....... ^, <br /> ADDRESS ADDRESS :—+-� • <br /> ..................4u..f.s..C ......................... . ......,........................................................................... ....... <br /> ADDRESS ADDRESS :Q <br /> (a. ..::.70 a................................................... .................................................................................... ....... <br /> PHONE PHONE <br /> ........................................................................................... .................................................................................... ....... <br /> PLUMBER WELL DRILLER �. <br /> O <br /> ADDRESS ADDRESS C iry <br /> 0........................................................................................... .................................................................................... ....... O ,.i <br /> PHONE PHONE Z N r <br /> DESCRIPTION 4. Sanitary Facilities: 0 6 0 <br /> 1. Work: 2. New Building Details No. Bathrooms .. ....... 0 <br /> Naw Building „� Type of Cgnstruction: No. Bedrooms .. ....... <br /> 4- <br /> Addition ,m,e„�j G,,,,, ,,,,,,,, Septic Tank Size Gals. .. ....... l <br /> .......... ryd . .. <br /> Sanitary .......... Size ...3. ... ft. x ......�..1.. ft. .. ....... <br /> Filling/Grading .......... Height....(.Q,J.l. Stories ......1....... 4a. Absorption Field Site: <br /> Moving .......... Area ... 7 ........... ........ Soil Type ............................ ....... .m . <br /> O <br /> Mobile Home .......... Slope .................................I ....... v <br /> Privy ........., 3. Use (describe exactly,-1 •family Perc. Rate ........................... ....... <br /> Well .......... home,garage, motel,etc.) Dry Well .. ....... <br /> ( S Seepage Trench o <br /> Subdivision " """' <br /> ......... ..PQ........e..........6. ................. <br /> Camping Unit Privy .. ....... i i <br /> Seepage Bed .. ....... <br /> ----------------------------------------------------------------------- <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fill. A. :� C <br /> Include road setback,side and backyard dimension and location and setback from all bodies of water. If property is local ed at <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersection, <br /> CLEARLY LABEL EXISTIN ND PROPOSED STRUCTURES AND ADDITIONS. o <br /> _____ __ _____ _____________________________________---_ <br /> 13G �� g. - <br /> 5. Lot Size: Fig. A. 6. Location: :f'I� <br /> ................ x .............. ft. — ........................ ...... sq.ft. ...................................................................... ........ <br /> tj <br /> 0 <br /> I�l J <br /> O <br /> e WCLr r <br /> Z <br /> 0 <br /> A <br /> a <br /> b <br /> N— <br /> Ao <br /> 0 3Z O Wyvm - Dy Wn>_ W <br /> c > o ccHr < Cn>. <br /> my3 <br /> p tp O <br /> O < D <br /> o 0 Eno ' <br /> co RI <br /> e. x A : O <br /> Signature of Owner or Agent Date <br /> O <br /> N <br /> Remarks ..................................................................................................... <br /> v+ � <br /> v <br /> ......................................................................................................... ............................. .....(./y/./.1/.).. ............ <br /> ......... .... <br /> . 8 : 8 <br /> /.(h. . .... N fOT N O N <br /> Inspection Date ....................................... <br /> ato <br /> Zoning Adminism <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary fa itties before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this application before a permit will <br /> be issued. Do not purchase or install a septic tank, do any plumbing or start any building until a permit has bee i issued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or specifications shall not be <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND AP ROVED. <br />