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Burnett Cgunty Office of Zoning Administrator u 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT ? 3 0 <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as < N <br /> shown herein. The undersigned agrees that all work shall be done In accordance with the requirements of the Burnett County Land Use m <br /> Ordinance, Sanitation Code, and <br /> with all other applicable County ordinances and the laws and regulations of the State of Wisconsin. <br /> ....................... +l...l..KW^�':... .''Y..... ......../.. � ... a ` 0 <br /> OWNER (please print) CONTRACTOR or SGRV YOR or P.GENT <br /> ....................................................................... <br /> r� ..,..w. ........:�Y! y3............................ <br /> ADDRESS ADDRESS m <br /> . . . .......................................................................................... <br /> ......... . ............................................................................... <br /> ADDRESS ADDRESS <br /> .. ......................................................................................... .PH.....ONE... .................................................................................. \Cr, <br /> -\ <br /> PHONE <br /> . . . . ..................................................................................... <br /> .. . .......................... ........................................................... <br /> PLUMBER WELL DRILLER <br /> i p <br /> . .......................................................................................... _. <br /> ADDRESS ADDRESS : <br /> . ......... ................................................... <br /> 0 <br /> PHONE .........•. .............................. <br /> �' PHONE Z o 0 ,� <br /> DESCRIPTION 4. Sanitary Facilities: ° <br /> 1. Work: 2. New Building Details <br /> No. Bathrooms .......... <br /> No. Bedrooms <br /> Type of Construction: """' f0 <br /> New Building <br /> Septic Tank Size Gals. .......... •( <br /> Addition .......... .................... ............................... <br /> Sanitary .......... Size ............ ft. x .............. ft. <br /> FiuinglGrading .......... Height.........'... Stories ............... 4a. Absorption Field Site: <br /> SoilType .................................... r <br /> Moving .......... Area ........... . ............................ » <br /> 0 <br /> Mobile Home .......... Slope .ate ................................... r� <br /> Privy Pend. Rate ................................... <br /> .. 3. Use (describ exactly, 1 -family Dry Well ..•.••.... <br /> Well . home,garagmotel, etc.) <br /> seepage Trench ...... <br /> Subdivision .. . .... ................. ............................. .... i i '. <br /> Privy <br /> Camping Unit .......... .............................4..................... Seepage Bed C� <br /> ______________------- __ ______ .N <br /> —-------- c <br /> Location of proposed structures and existing structures,well, seNage systems, roads, etc.,should be sketched in Fig. A. Include road W Q <br /> setback, side and back Yard dimension and location and setba k from all bodies of water. If property is located at a highway inter- T <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING 4 �, o <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITI. NS. — ° <br /> ----------------------------------------------------------- <br /> 5. <br /> -------5. Lot Size: Fig. A. 6. Location: vt <br /> ................ ft. x .............. ft. . .ft. ............................................................................... <br /> e <br /> < N <br /> O N <br /> 0 <br /> 0 <br /> ° <br /> >5 <br /> Z <br /> ° <br /> d <br /> � F <br /> D - m <br /> 0 0' n 77 <br /> nm 3 <br /> on Mq <br /> o � <br /> m <br /> y-�6 C <br /> Signature of Owner or Agent Date X <br /> m <br /> Remarks ......................................................................................................................................................................... C <br /> ............................................................................................... — <br /> ....................................................................................... .................. . . . . ' ' <br /> rr <br /> Inspection Date ....................................... % .................. U 8 0 o rr <br /> ............. . <br /> Zoning Adm nistrator Fu <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 ust be attached to <br /> this application before a permit will be issued. Do not purchase or install a septic tank, do any plumbin_ 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 Zo mg Adm nistrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND (,APPROVED. <br />