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,I��. <br /> Burnett County Office of Zoning Administrator ( 0 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 , <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 /> ... �.. . /...... and regulations of the State of Wisconsin. 3 ma � <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws 7 B OA <br /> �... ............ ............. ...... �-/s,,��//r'`C sw ........................ .... <br /> OWN R (please print) CO ! ACnTCR or$VRVEYOR or AGENT a <br /> r�� ../..6..1 � . � . 7a-� u!./........ ... Y.o ... .... a <br /> AD E$S ADDRESS <br /> ADDRESS ADDRESS � <br /> 76'.-.y1' <br /> ..... <br /> - 9 0 <br /> � .. ... ....... ...........G�... ........................................ ............................................................................................ <br /> PHONE PHONE <br /> ........................................................................................... . <br /> PLUMBER ...LL....................... . ... . ........................................ <br /> WE. DRILLER ... ..... ..... ..... <br /> ADDRESS ........................................ _ <br /> ADDRESS <br /> n o i <br /> ........................................................................................... ................................................................. ......... <br /> .. ................ N <br /> PHONE PHONE Z o r <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> i. Work: No. Bathrooms <br /> 2. New Building Details <br /> New Building .......... Type of Construction: No. Bedrooms ......... [ <br /> Addition .......... .................................................... Septic Tank Size Gals. .......... <br /> Sanitary Size ft. x ft. <br /> .......... .............. .............. <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area ........................................... Soil Type ..........................I...... <br /> ... r <br /> rc <br /> Mobile Home .......... Slope .......................................... : .. <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Wel) .......... home, garage, motel, etc.) Dry Well .......... <br /> Subdivision ✓ Seepage Trench .......... <br /> .......... .................................................... <br /> Camping Unit „ ,,,,,,,, Privy .......... <br /> .................................................... Seepage Bed <br /> --------- ------ --------------- ------------- v> <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched In Fig_ A_ Include road a <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property Is located at a highway inter- °- <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING <br /> A <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o <br /> -------------------------_____________________________________________ <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... sq. ft. ............................................................................... <br /> 01r J N <br /> ,�pj G ur NP40 <br /> J V , <br /> r _ <br /> z <br /> r7 0 <br /> r <br /> 7J (n r L rn M 2 <br /> n Q < c m <br /> m n f <br /> Z o. a <br /> :\ 0 <br /> \ s <br /> o <br /> ............................. 'A"'g'................................... ...........�� ” 5 �u o c <br /> ............... o �: <br /> Signature of Owner or Agent Date <br /> X <br /> Remarks ......................................................................................................................................................................... "^ m <br /> ....................................................................................................... ... ... ................ ...................... i : <br /> .. II .O Nao' fUm <br /> Inspection Date ....................................... <br /> .. ........ ..:..Za:1K. ............. u 8 o m <br /> 9... . . . J <br /> Zonin Admini trator <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 riot purchase or install a septic tank, do any plumhing 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 />