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Burnett County Office of Zoning Administrator Ln - o Z <br /> 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 -� N O <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use <br /> Ordinance, Sanitation Code, and with gll other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a �1 <br /> w �(��1{/1 a <br /> ... .......... ..... .�..........:o..� ..s ° <br /> �/Q ................ ......... ....................................................... <br /> OWNER (Please Print) • � ����������� � C � <br /> CONTRACTOR or SU RVEVOR or AGENT <br /> .. ... . <br /> 5� . ...... � O...... oY. A <br /> d <br /> ADDRESS ADDRESS ,. <br /> �. ..y.....,..!^J'. .......5.. .s3�........... . .......................................................................................... <br /> ADDRESS ADDRESS :�, <br /> �...? ..-...32o........................................................... ;. <br /> ........................................................................................... <br /> PHONE PHONE <br /> ........................................................................................... . . ..L...DR.....ILLE.. R.. ....................................................................... :�`, <br /> PLUMBER WEL <br /> ........................................................................................... <br /> ADDRESS .AD......RE.. S................................................................................. <br /> . O <br /> DS <br /> m V7 <br /> _. <br /> o <br /> . . .................................................................... PHONE . ..................................................... 0 <br /> PHONE <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> 1. Work: 2. New Building Details No. Bathrooms <br /> New Building T No. Bedrooms . ........ a <br /> yp o Constru tion: <br /> Addition ,,....., ,�, ...p,„�„ Septic Tank Size Gals. .......... ; <br /> .. .... <br /> Sanitary .......... Size ...Z..�.... ft. x ..o�.�...1... ft. .......... 4*,.: <br /> Filling/Grading F— 4a. Absorption Field Site: <br /> .......... Height.. .... /.. Stories ............... P <br /> Moving .......... Area Soil Type .................................... �T r <br /> Mobile Home .......... ........................................... Slope <br /> Privy ,,,,,,,,,, 3. Use (describe exactly, 1 -family Perc. Rate ................................... .\ <br /> Welke .....I.... home,garage, motel, etc.) Dry Well .......... f <br /> Subdi'v7sion .....I.... ......q tl k..n+.A. Seepage Trench .......... lL•, <br /> Camping Unit .......... ..7 Privy <br /> .. .................................................... Seepage Bed <br /> .......... <br /> ----------1�*----------------------------------------------------------- �t i <br /> Location of proposed sTructures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. Include road 4� e <br /> setback, side and back <br /> yard dimension and location and setback from all bodies of water. If property is located a[ a highway inter- <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING t N. <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. 7 o.y.•Y <br /> ------------------------ <br /> — ------------------------------- <br /> -- A. <br /> 5. Lot Size: —��---�---- 6. Location <br /> ................ ft. x .............. ft. — . . ...�C../p. ....`....er Fig.sq.ft. ............................................................................... <br /> 19A �• r- (�A1 � � ��..--N <br /> N p' <br /> L O <br /> J <br /> v ° � Gor <br /> (o0 <br /> Z <br /> �tl o <br /> pit M 0 m z <br /> C J l' N O C K <br /> m p a a < — F <br /> C. d Ei pJ <br /> 01 < N .� m C <br /> Z <br /> 20 4 <br /> J <br /> :5l Fin <br /> Signature of Owner or Agent Date C <br /> X M <br /> RemarksT m <br /> ......................................................................................................................................................................... 0 <br /> ........................................................................................................................................................................................ f» <br /> ............................................................................................................ ............................... ..... .................................... o <br /> u.II N m <br /> Inspection Date ....................................... <br /> ......... /'� . ......... o' u 'o u o u, <br /> . . . ......... m <br /> Zoning Ad..minis rator to <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 Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />