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Burnett County r Office of Zoning Administrator a T -- 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. <br /> o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as v, <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 ;U <br /> Ordinance, Sanitation <br /> Code, and with all other applicable County Ordinances and the laws andel regulations of the State of Wisconsin. 3 <br /> AWgiR <br /> ............................................ L;,l�,-cuCY...f r !:Yp,y,",,'��: ..:.................. \ � O(please print v / CONTRACTOR or SURVEYOR or AGENT a .\J <br /> . . . .......... <br /> Z ............................................................. <br /> ADDRESS O ADDRESS <br /> ?... ..G..v.... !�..�... ..w.......:s.Y.�� . <br /> .3....... ........ . . . . . <br /> ADDRESS .......................................................................... A <br /> ADDRESS r � ry\ <br /> i\ <br /> PHONEPHONE................................................................................ <br /> ........................................................................................... ............ <br /> ................................ ...................... <br /> ....... .............................. W <br /> PLUMBER . . ..................................................................................... .� <br /> WELL DRILLER � i <br /> ........................................................................................... .ADDRE.. .... . .................................................................................... '0 <br /> ADDRESS SS <br /> 0 o <br /> c <br /> PHONE . . . . . ..................................................... ~ <br /> PHONE Z N <br /> DESCRIPTION <br /> 4. Sanitary Facilities: ° o 0 0 <br /> 1. Work: 2. New Building Details No. Bathrooms <br /> o <br /> New Building Type of Construction: No. Bedrooms .......... <br /> Addition .......... .................................................... Septic Tank Size Gals. .......... i i <br /> Sanitary .......... Size ft. x .............. ft. .......... <br /> Fillings Grading ,,,,,,,,,, Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving Soil <br /> Type .................. ......... .. <br /> .......... ..................................... r <br /> Mobile Home Slope .......................................... <br /> .......... ; <br /> o •• ;� <br /> Priv Perc. Rate ................................... 3 <br /> Privy .......... 3. Use (describe exactly, 1 -family Dry Well .......... F <br /> Well .., home,garage, motel, etc.) <br /> y ; f <br /> Subdivision , ,...,,,. Seepage Trench .......... <br /> .................................................... <br /> Camping Unit Privy .......... <br /> ... A^+ <br /> h <br /> Seepage Bed .......... <br /> ---------------------------------------------------------------------- <br /> Cn <br /> Location of proposed structures and existing structures well, sewage systems, roads etc., should be sketched in Fig A. Include road M. .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- 1 d <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING JJo <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. C �� <br /> 5. Lot Size: Fig. A. 6. Location:V <br /> ....... ...... ............................... <br /> / <. <br /> .. ........ s ft. ����dd .... .........I..... o � ; <br /> I <br /> I r <br /> r� <br /> rI S <br /> C�1 r g <br /> �yp� �T <br /> ^\ Z \ <br /> Thy <br /> M N r W m Z <br /> C . N % c N <br /> _ _ ' f <br /> B (Jl D. � d <br /> Z oo' . > a <br /> O > na 0 70 <br /> m <br /> o <br /> Signature of Owner or Agent Date <br /> X . <br /> Remarks ......................................................................................................................................................................... �+ :y� rn <br /> ,o O <br /> ........................................................................................................................................................................................ <br /> Wn <br /> ..................................................................................................... . .- �. . ..��... .. cr. ............. <br /> Inspection Date ....................................... . <br /> (ral <br /> � " ' <br /> ............. a <br /> M <br /> ...................... <br /> 888 <br /> Zoning Adminis rotor /�/ 888tn <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 />