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Burnett County Office of Zoning Administrator iu 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 0 ;gyp <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use n <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 is <br /> a <br /> ' / G yvue. Rrt,T z <br /> OWNER (please print) /t CONTRACTOR <br /> or SURVEYOR or AGENT 0 � <br /> ADDRESS..`1SQ. ..('tV.4'r..N.C....................................... . .?.0.t...1:�?�:.... ../....................................................... � �L \. <br /> ADDRESS <br /> NlrriIII o7At.t .... . ... . . <br /> .uS MtNn) ` 2 VN�Sc..... F93.................. <br /> ADDRESS .. ..z . . �1t�3S ....... .}... ... <br /> ADDRESS :f+ <br /> k <br /> ........................................................................................... . . . . .................................................................................... �\ <br /> PHONE " " <br /> . .............................................................................. PHONE <br /> ........... . ................................................................... <br /> PLUMBER ......................... <br /> WELL DRILLER <br /> ........................................................................................... . .......................................................................................... O ` <br /> ADDRESS ADDRESS <br /> o <br /> ........................................................................................... PHONE................................................................................ <br /> .......... <br /> PHONE • <br /> DESCRIPTIONo o <br /> 4. Sanitary Facilities: <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details •••.. <br /> 0 ;.11 <br /> New Building Type of Construction: No. Bedrooms .......... 0 ,V <br /> Addition ........ , Septic Tank Size Gals. ......... <br /> M <br /> Sanitary ......I... Size .............. ft. x .............. ft. ......... <br /> Rif ling)GradingHeight............. Stories ............... 4a. Absorption Field Site: <br /> Moving Area Soil Type ' <br /> .......... ........................................... .................................... <br /> o <br /> Mobile Home .......... Slope .......................................... .. <br /> Privy .•........ 3. Use (describe exactly, 1 -family Perc. Rate ................................... w i <br /> Well .......... home,garage, motel, etc.) Dry Well ........., <br /> Subdivision ,,,.,,,,, Seepage Trench .......... 1 <br /> .................................................... <br /> Camping Unit .......... Privy <br /> .................................................... Seepage Bed <br /> Location of proposed structures and existing structures well, sewage systems, roads, eta, should be sketched in Fig. A. Include goad LN .� <br /> setback, side and back yard dimension and location and setback from all bodies of water_ If property is located at a highway Inter- l I nom. <br /> section, show the intersecting highways and the setbacks required along them and at the Intersection_ CLEARLY LABEL EXISTING 5 <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> --_--__—__ I <br /> 5. Lot Size: Fig. A. 6. Location: t <br /> ft. x .............. ft. . ............................... sq. ft. ............................................................................... d <br /> f <br /> rn <br /> m <br /> 'SeC- 02AV4iWG AT-rAc"Iti , MtS A-1l7PLLC,4Tt01J tS Fp2 N o <br /> [� 0 7 <br /> A Y it lt—F 'CO IIySTcat1 RZLVATC— �2.l��ht Aj WtZNt n7 A <br /> O <br /> Z� V..tttpE. Cr�SEtvtL�T � TN2ou�t-a A trtr�r�st-1 Alt.—A AwUC� � ; � <br /> 0 <br /> A Poi 2Zy Ltircie <br /> s <br /> a^^ <br /> T f1� <br /> Q <br /> Z <br /> 0 <br /> v <br /> 7 <br /> as <br /> 07 N r v � to m 2 <br /> N N d - 0 6 0 <br /> z o N > a m <br /> ............. � ............ �l9,kS p <br /> Signature of Owner or Agen� v Date o C_ <br /> Remarks ............................. .......................................................................................................................................... „ m <br /> v <br /> ........................................................................................................................................................................................ ' <br /> p_ II <br /> V <br /> m <br /> Inspection Date ....................................... <br /> « <br /> ..... .....I...... / ......... .......................... . :I^: U O N O fNT <br /> Zoni Administrator o 0 0 0 o N <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 <lisposaf 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 Ine made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />