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Burnett County Office of Zoning Administrator o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT a 3 <br /> o <br /> < <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as H <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m CPQ <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> / :.. �1 � <br /> ......................................... ............. .......... . .......�5. ........................... <br /> OWN R (please print) <br /> CON <br /> JR Cor SURVEYOR or AGENT a <br /> ..�� . z... ..... ...... .............. ....... .t�. ... . .. .:.. .,...... ................... ...... . d <br /> A ESSn H ADDRESS -. <br /> .. .......... ? .....7.a .,.w�....... SY.�a.S�..... ................ <br /> ADDRESS ADDRESS <br /> ............ <br /> PHONE................................................................................ .PHONE.................................................................... :V <br /> .............. ' <br /> ........................................................................................... 'W"'E"L......DR...ILL......ER......................................................... <br /> PLUMBER WEL <br /> ADDR ESS............................................................................ .ADDRESS............................................................................ m <br /> » O <br /> PHONE <br /> PHONE Z r <br /> DESCRIPTION 4. Sanitary Facilities: n o0 0 <br /> 1. Work: No. Bathrooms ° M <br /> 2. New Building Details """"" 3 0 <br /> New BuildingNo. Bedrooms <br /> .......... Type of Construction: <br /> m <br /> Septic Tank Size Gals. y <br /> Addition """"" i., Q ' <br /> Sanitary .......... Size .............. ft, x ft. .......... 75 <br /> FillinglGrading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area Soil Type .................................... >r o <br /> Mobile Home .......... Slope vt '+ <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... w i <br /> Well ,,........ home,garage, motel, etc.) Dry Well .......... d <br /> Subdivision ✓„ Seepage Trench .......... o i <br /> ........ .................................................... <br /> Camping Unil .......... Privy .......... <br /> .................................................... ' <br /> Seepage Bed .......— E <br /> e N <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig_ A. Include road <br /> T <br /> setback, side and back yard dimension and location and setback from all bodies of wafer. If property Is located at a highway inter- 1\ a ' <br /> section, show the intersect ng highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS0 <br /> . v p' <br /> ---------------------------------------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. . ............................... sq. ft. ............................................................................... <br /> jJ '�Ij UPJa n <br /> iZ `5`° isy • v U °. <br /> €W <br /> = o <br /> Z Q- <br /> 0 <br /> 1 )J — 7J <br /> I � <br /> N <br /> i c 9 m M m <br /> a m v <br /> Z <br /> - m <br /> iijo <br /> .............................. ...................................... 9a o c <br /> Signature of Owner or Agent Date <br /> X � <br /> Remarks ......................................................................................................................................................................... <br /> " €`C v <br /> ..................................................................................................... ... <br /> Qt U N <br /> Inspection Date ....................................... ............... .. .. ................. <br /> ..... . o � o' v, m <br /> �t. .... .��....K.. <br /> Zoning Ad inistrator J 8 8 8 8 8 8 cn <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 lie made without approval of the Zoning Adm inistrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />