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Burnett County Office of Zoning Administr for Iv ;F <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 0. ' <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements oi the <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wisconsin. n <br /> J7�/... ...... ......... . tet .}.................. ..................................................................................... ...... As _ <br /> OWNER (please pfntl CONTRACTOR or SURVEYOR or AGENT $ <br /> s.T. 2.......��G.�..:�...... �X.....-3,F,02- - - <br /> ................... ......................................... W <br /> ADDRESS ADDRESS <br /> ADDRESS ADDRESS ' <br /> . �- � L `�.... .. .. k...P�.. ....... <br /> .......................... ....................................... . n `• _. <br /> PHONE PHONE <br /> .... ...... ............................................................................... . . . <br /> WEL..L..DRIL.... L...... ............................................................. ....... �•---^ <br /> PLUMBER ER.. a� <br /> ADDRESS ADDRESS m 0 <br /> o <br /> ........................................................................................... <br /> .P....HO...NE............................................................................ ....... O w <br /> PHONE Z N <br /> r <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details "" c <br /> Now Building No. Bedrooms <br /> .. .. Type of nstruction: •• ....... <br /> Addition X "�rYt••-t Septic Tank Size Gals. ...... p <br /> ... . .... ............. .... ................................. .. . <br /> Sanitary .......... Size .............. ft. x .............. ft. <br /> .. ....... <br /> Filling/Grading ,,,,,,,,,, Height............. Stories ............... 4a. Absorption Field Site: ; <br /> Moving Area Soil Type ............................ ....... r <br /> Mobile Home Slope G <br /> Privy .......... 3. Use (describe exactly,'1 -family Perc. Rate ........................... ....... <br /> Well .......... home arage, motel etc. Dry Well .... �W <br /> [-� p t9 .. ... <br /> Subdivision eepage Trench Z ' <br /> Camping Unit .......... Privy .. ....... � <br /> ............................................ Seepage Bed <br /> -- — <br /> .. ....... (n <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fill. A. =-.Q c 0' <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is located at 1 �— <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersection. <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. — I _ <br /> ------------------------------------------------------------------- `. n <br /> 5. Lot Size: Fig. A. 6. Location: <br /> L <br /> ................ ft. x .............. ft. — .............................. sq.ft. ...................................................................... ........ <br /> n <br /> L �0O1�e. 2U� t N L�Ei <br /> 0 <br /> f <br /> fo <br /> � T <br /> X <br /> Z <br /> d <br /> r <br /> le <br /> zy <br /> G <br /> CnW00CCM <br /> 0 �rr < > > n - - m <br /> O ep m <br /> Ut N n '� <br /> c <br /> s <br /> m <br /> VRearks'!.:O.f..O.w <br /> or Age Date o C <br /> m <br /> m •� <br /> u, <br /> ................................................................................................................................................................................... .... P : o <br /> rob <br /> o <br /> 0 0 <br /> N D D N m <br /> .... ....................................... .... <br /> Inspection Date ....................................... .. .......fes......inistrat.................... .... v, <n v, o o m <br /> Zoning Administrator 8 8 S S to <br /> NOTE: A preliminary site inspection must be made and site approval 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 appl cation 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 beeii issued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or 5pecifications 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 />