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r <br /> Burnt County Office of Zoning Administrator -g <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT m <br /> o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and q <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the c N <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 `8 i <br /> regulations of the State of Wisconsin. l _? '; — <br /> eA <br /> . .:...Qo'Oc /.... 'e1y.. ....................... .. .... .... .. .. ... .$ .. ...... <br /> Cyt .. ... . . ..... .. <br /> OWNER (please print.;.. .�/ CONTRACTOR or SURVEYOR or AGENTf <br /> ... ............................................................................................ a + ' <br /> ADDRESS ADDRESS ; iA <br /> .. 1.. f1I........�1.1..1. !W.......... et7 ............................................................................ <br /> ADDRESS W ADDRESS :- <br /> 6 ............................................................................................ co ; <br /> PHONE PHONE SJ <br /> ........................................................................................... ..W..EL..... <br /> L...D. ..RILLE.. .. R ..... ....................... ............................................. <br /> PLUMBER <br /> ........................................................................................... . ......................................................................................... O <br /> ADDRESS AD.. DRESS E <br /> 0 o <br /> ...... <br /> . ................................................................................... O <br /> PHONE PHON........E <br /> DESCRIPTION Z N r <br /> 4. Sanitary Facilities: P o r <br /> 1. Work: 2. New Building Details No. Bathrooms c <br /> No. Bedrooms <br /> New Building .......... Type of Construction: '••"'•"• <br /> AdditionSeptic Tank Size Gals. .......... <br /> .......... .................................................... <br /> Sanitary ...... . Size .............. ft. x .............. ft. .......... Q <br /> Filling/Grading Height............. Stories ............... 4a. Absorption Field Site: <br /> ... ; <br /> Moving .......... Area Soil Type ..........................I......... r <br /> ........................................... r� o <br /> Mobile Home Slope .......................................... �� .. <br /> .......... <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> p , <br /> Well ....•••... home,garage, motel,etc.) Dry Well .......... m i <br /> Subdivision . ...-,... Seepage Trench Z <br /> .......... p <br /> Camping Unit .......... .................................................... Privy .......... ;.,y <br /> .................................................... Seepage BedQ <br /> -------------------------------------------------------------------- r- `� €LA�'{� <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. i "1 <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is located at <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersection. o v`—, <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. :� r o 0 <br /> ----------------------------------------- ---------------------------- :� � <br /> 5. Lot Size: FIII <br /> . A. 6. L cation: <br /> ................ ft. x .............. ft. — ...... ................ ... sq. ft. <br /> 11 <br /> 0. <br /> o h n <br /> o <br /> J r <br /> S r Cl /T7Z It <br /> 1 a <br /> J" O <br /> / M <br /> 1 <br /> r C <br /> DW D lDm � <br /> d <br /> C <br /> 0 < o n c m <br /> SD. �a� many <br /> n� mn <br /> ms ..... .... .............. ... ...................................... x n : m <br /> 'Signature of caner or Agent Date o <br /> o , <br /> T a <br /> Remarks/........./. ........... ....//...`!............... ... ...............................,......................................................................................... m <br /> N!t fur. ! l .� 1.iv 1..:i.......(S.r ....�.�....�.. . � 7``' �j��/'�i <br /> ..................................................�... .. .......... .. ....... ... ....... <br /> ............/�.-... ......6P...... �r7 Cl.. a <br /> . .. .. ..:�. ... . � H <br /> Inspection Date ,,,• o N m <br /> .. .......o 8 .. ......... ............... $ g <br /> Zonin Ad Inistrator <br /> NOTE: A preliminary site inspection must be made and site proval granted on all structures involving sanitary facilities before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this application 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 or specifications shall not be <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />