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ei9z_e)-219f . <br /> Burnett County Office of Zoning Administrator T -- 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 c <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 ma <br /> .......................................... ....... . . ... . ............................................................... :� o <br /> a <br /> ...... ............ <br /> OWNER (Please print) CONTRACTOR or SURVEYOR or AGENT M �r— <br /> AD ESS ADDRESS � n <br /> esu �. 5S <br /> .. / <br /> ............ . .......... .. .................................................... ............................................................................................ <br /> AD RESS ADDRESS <br /> ....... ..... ..y. ..- ,36 $x. .. . y <br /> p <br /> PHONE PHONE <br /> ........................................................................................... .WEL.. ... ...L D.....R.ILLER............................................................................. <br /> PLUMBER <br /> 0 <br /> ........................................................................................... .A..D..DRES............................................................................. C.......... �. <br /> ADDRESS S <br /> 0 o <br /> ............ Z r <br /> PHONE PHONE � <br /> DESCRIPTION 4. Sanitary Facilities: ° or C <br /> ° <br /> 1. Work: 2. New Building Details No. Bathrooms <br /> � No. Bedrooms ........ o <br /> r" <br /> . . 0 <br /> New Building ,,,,Ix Typ f Construction: <br /> Addition ••• ...... ...,,, l:a R....•....•••. ••••• Septic Tank Size Gals. .......... <br /> Sanitary .... Size ..J.e� .. ft. xA0 ... ft. <br /> FiningiGrading ,..,, Height.... ..... Stories S:}:.... 4a. Absorption Field Site: i <br /> Moving .......... Area ... ............................... Soil Type .................................... . r- <br /> 0 0 <br /> Mobile Home Slope .......................................... <br /> Privy ..,,,...,, 3. Use (describe exactly, 1 -family <br /> Perc. Rate ................................... <br /> Well Dry Well O <br /> ,......... home,garage, motel, etc.) '••""-' ' <br /> Subdivision ............. ' . <br /> Seepage Trench ..... <br /> .......... <br /> Camping Unit b . ... . Privy ..........._ <br /> .......... ............ . : 0. ......... .... <br /> pT <br /> W :"r/ <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 <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 /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. N : f. m <br /> 0 <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. . ....JO.C�� ......,.✓V�'`.�..LV.f::�..s .........T-41 00 ��.....✓ O :� <br /> .................. sq. ft. _ <br /> :Fist <br /> 5 m <br /> 5� n <br /> N 0 <br /> Q <br /> oi <br /> 3 30 — <br /> 6 ' <br /> : t <br /> iwn G <br /> M <br /> -oan a: <br /> Cqn <br /> -PA-re(y61 <br /> ,...... .. .. . .. 6-...�- .s = <br /> Signature of Owner or Agent Date <br /> X <br /> Remarks ......................................................................................................................................................................... m m <br /> e}9t{ <br /> v <br /> ........................................................................................................................................................................................ II <br /> .......................................................................................................... .. .... .... .. <br /> U : <br /> Inspection Date ....................................... ... ... ?� i u N o $ ' IN <br /> Zo Ing Administrator $ $ $ $ $ <br /> NOTE. A preliminary site inspection must be made and site approval granted on all structures involving sanitary facili n <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test most be attache I 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 Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />