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Burnett County Office of Zoning Administratord o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> 0 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as m <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 :(5 <br /> Ordinance, Sa�ltaTion C and with all other applicable Count Ordina e�and the laws and regulations <br /> �ns of the State of Wisconsin 3 0- ?0 <br /> rr y g scons <br /> .. ........ • 1 - 1. �) ( ............. <br /> .... .. . .. ...... f.(. ...1A(. .. n.:..... C _ o <br /> OWNER (please pant) .i t CONTRACTOR or URVE�OR or AGENT a <br /> 1.x.1... !.�...L .(�` .....�. ...: :..5�.!.-�...... . .. t3o�c.... ............................................................ FF— <br /> cc Al y <br /> � alR\SS 1Q. E :J.).}. ... ....— ......... D.I S�k!J .:1 .. �V .:...,..1.`t.0................... <br /> .... ..... ...... f..... .. <br /> ADDRESS ADDRESS iiijl�� ,�� <br /> ........................................................................................... . .......................................................................................... W <br /> PHONE PHONE uj <br /> ........................................................................................... WEL. . . .....D.RI. .. <br /> . LL....ER....................................................................... <br /> PLUMBER L <br /> ........................................................................................... .. ........................................................................................ .O tJ <br /> ADDRESS A..DDRESS 0 '(D <br /> ........................................................................................... . . . . ................................................................................... N <br /> PHONE PHONE Z o r <br /> DESCRIPTION 4. Sanitary Facilities: ° o 0 <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details ••••••••• ' 0 <br /> New Building Type of Construction: No. Bedrooms .........f Addition .......... .................................................... Septic Tank Size Gals. ......... < <br /> Sanitary Size ft. x ft. <br /> FillinglGrading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area Soil Type ................................... r i <br /> o <br /> Mobile Home .......... Slope ......................................... .. <br /> PrivyPerc. Rate ................................... <br /> .......... 3. Use (describe exactly, 1 -family 70 <br /> well „ ,. ., home,garage, motel, etc.) Dry Well .......... <br /> Subdivision Seepage Trench .......... <br /> ,.X <br /> .,..,' ' .................................................... <br /> Camping Unit .......... Privy .......... <br /> .................................................... Seepage Bed LX, <br /> ----- ----------------------------- ------ 1 i <br /> ce <br /> Location of proposed structures and existing structures, well, sewage syste ms',.roads, etc., should ba sketched In Fig_ A_ Include road f2 p. <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property Is located at a highway inter- _o- <br /> section, show the Intersecting highways and the setbacks required along them and at the Intersection. CLEARLY LABEL EXISTING ' o <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. vl <br /> ____________________________________________________________________.__ J <br /> 5. Lot Size: Fig. A. 6. Location: \' <br /> ................ ft. x .............. ft. . ............................... sq. ft. ...................._......................................................... E <br /> `fir 1 rT• N o� <br /> JC <br /> � o <br /> as <br /> 1, llllll 7J <br /> N <br /> J <br /> N <br /> t \ N <br /> -.M to W Z <br /> (A n f <br /> m R <br /> coo ? a n a <br /> -O o <br /> uQ� 3 <br /> 0m rr <br /> ........................ 'n-e' ............................................. ...................................... �o . . . C_ <br /> Signature of Owner or Agent Date <br /> X 7 <br /> Remarks ......................................................................................................................................................................... m /, gr <br /> A <br /> ....................................................................................................... <br /> ........................ ... ... .. <br /> ............ <br /> Zoning <br /> N N d N rT <br /> Inspection Date ....................................... .... . .li' .. ........... ... V1r .. �.�....... .... a u, o u o u <br /> Zoning Ad ministrial g o 0 0 0 o V <br /> NOTE: A preliminary site inspection must be made and ite 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 most 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 ce made without approval of the Zoning Administratoi. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />