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Burnett County Office of Zoning Administrator W 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3 o yV <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as .< — :G <br /> 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 � iv <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wlsconsi n. 3 a G <br /> ... ' ..................................... .... :..5° ................................. _ o <br /> a <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT <br /> ........................................................................................... .. ...... ......... <br /> ........... <br /> ..... <br /> ..... <br /> .... <br /> .... <br /> ...... <br /> ...... <br /> ........ <br /> .................... <br /> ADDRESS A..DD.. RESS.. <br /> .......... <br /> ........................................................................................... .AD.....DRE......S..................................................................... <br /> ADDRESS S `p <br /> .................................................. <br /> ........................................................................................... .......................................... <br /> PHONE PHONE <br /> ..................................... ............ <br /> ........................................................................................... .W'E' D..........R.I........LLER................... . :U\ <br /> PLUMBER <br /> ........................................................................................... ............................................................................................ i �. ° <br /> ADDRESS ADDRESS m 0 <br /> ................•.......................................................................... . .........PHONE................................................................................. D » . <br /> PHONE Z r. <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> It, <br /> 1. Work: 2. New BuildingDetails No. Bathrooms .......... o <br /> d <br /> Berooms """"" <br /> New Building .......... Type of Construction: No. <br /> Addition .................................................... Septic Tank Size Gals. .......... <br /> Sanitary .......... Size .............. ft. x .............. ft. .......... W <br /> Fitlingl Grading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> c <br /> Moving Soil Type .................................... <br /> .. . r <br /> ........ Area ........................... ............... o <br /> Mobile Home .......... Slope .................................I........ ^ <br /> Privy .......... 3. Use (describe exactly, 1 -family Pere. Rate ................................... E <br /> Well .......... home,garage, motel, etc.) Dry Well .......... I <br /> ,i Seepage Trench <br /> Subdivision ,,........ G <br /> .................................................... Privy <br /> Camping Unit .......... ..........................—....................... <br /> .......... <br /> Seepage Bed ......... <br /> ------------------------------------------------------------------ <br /> Location of proposed structures and existing structures,well, sewage systems, roads, etc., should be sketched in Fig. A. Include road Q ohy <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 rm <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o <br /> 5. Lot Size: Fig. A. 6. Location: :m <br /> ................ ft. x .............. ft. — ............................... sq. ft. ............................................................................... <br /> V V N <br /> a y3N °0 <br /> 3 <br /> V : 0 <br /> ° <br /> 7 <br /> J <br /> t D <br /> m \ <br /> Z <br /> O <br /> JJ <br /> m <br /> m <br /> V <br /> r a �E in W Z <br /> C d r d C N <br /> OQ <br /> 5 N6 C: y^ n rD <br /> zn <br /> o n 31 <br /> o <br /> 1z" Co <br /> � r'M Rt <br /> 6,a.�-.y5.............. o <br /> Signature of Owner or Agent Date <br /> X <br /> T <br /> Remarks ......................................................................................................................................................................... m.� <br /> m � 0 <br /> e» <br /> :W I <br /> ................................................................................I...................... .. .................... ........... m <br /> I <br /> Inspection Date p o.� `" 8 8 8 o m <br /> ..................................._. Q!M.....L...:....... ............... . .. b: m <br /> Zonin Administrator .. ........... <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, 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 be made Without approval of the Zoning Administratol . <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />