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Burnett County Office of Zoning Administra or <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described ind '� tt ^ -� <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of he " c (� <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws nd 3 <br /> regulations of the St of Wis onset. . <br /> c.Y,° .... d. .c .................................... .... Q.l 1.....0 racte.l..................................... ..... <br /> OWNE (Please print) <br /> CO RACTOR ......r SURVEYOR or AGENT 0 <br /> .P k <br /> ADDRESS ADYr ,....1/Ill1 ..... ............... .... ou k�....1d <br /> �p ........ <br /> Dj1E 1 C .L...�.V.-.,1�... � .................... ..... n <br /> ADDRESS ADDRESS <br /> ........................................................................................... ..P. ............................................................................. ..... <br /> PHONE HON......E <br /> ........................................................................................... . . . ............................................................................... ..... <br /> PLUMBER WELL DRILLER �f\ <br /> ........................................................... ................................ i .nn'L' J <br /> ADDRESS ADDRESS <br /> O <br /> O <br /> PHONE <br /> ........... <br /> .. . . PHONE ' <br /> .. ............. <br /> N <br /> DESCRIPTION 4. Sanitary Facilities: ° o � <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details •••• ••�•• � <br /> Now Building No. Bedrooms <br /> • o <br /> Type of Construction: i <br /> Addition .................................................... Septic Tank Size Gals. .... ..... i ,� ; f <br /> .......... <br /> Sanitary .......... Size .............. ft. x .............. ft. .... ..... <br /> Filling/Grading ......••.. Height............. Stories ............... 4a. Absorption Field Site: i <br /> Moving .......... Area ....................... . Soil Type .............................. ..... r <br /> Mobile Home .......... Slope .................................... ..... <br /> Privy .......... 3. Use (describe exactly,'1 -family Perc. Rate ............................. ..... <br /> ,. . ,... home,garage, motel,etc.) l <br /> Well Dry Well .......... m <br /> Subdivision „),• Seepage Trench ... ..... z <br /> .. o_ _. <br /> .................................................... � ,; . <br /> Camping : <br /> '•"•' Priv .........Seepage Bed .......... - <br /> ---------- ------------------------------_ ___ <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig A_ - C <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is local d at; <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersects n. <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. - o' <br /> __—_____ _______________ _____________ _— <br /> 5. Lot Size: Fig. A. 6. Location: ? i <br /> ................ ft. x .............. ft. . ............................... sq.ft. ..................................................................... . ....r. .� E E STl <br /> .. <br /> i <br /> e�Y o <br /> �Y g� <br /> Yla 11 <br /> Yc es <br /> Yo <br /> 0 <br /> i <br /> 9 <br /> �m <br /> Z <br /> O <br /> m <br /> 6 <br /> min —' am nay <br /> ZOy_ � •G N � <3 tp= 3 <br /> O w D 1 <br /> m n . <br /> a = m <br /> c n o Q <br /> ....................................... ...................................... x r, <br /> m <br /> Signature of Owner or Agent Date o <br /> o , <br /> m •• <br /> o : p <br /> .......................................................................................................... ... .................. .. .... .... .. . .......................... .. 8 <br /> f . . .Tl....�or <br /> NmN � ; vm <br /> Inspection Date ....................................... ...... .... ..?. .. . v' u, v, o o ut mZoning Admin '�) 8 8 8 8 8 8 ca <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary fac lities before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this appli ation before a permit will <br /> be issued. Do not purchase or install a septic tank, do any plumbing or start any building until a permit has been issued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans ors ecifications shall not be <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APP OVED. <br />