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Burnett County Office of Zoning Administrall or <br /> APPLICATION FOR SANITARY - LAND USE - BUILDING PERMIT 3 <br /> o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described nd <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of he <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws z nd 3 <br /> regulations of the State of Wisconsin. » "' <br /> eok1..S.YaA]eS........................................................... ... . .................................... .... m <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT <br /> .......HC...7.0......................................................................... . . .................................................................................. ..... <br /> ADDRESS ADDRESS �. <br /> .Webstzr..,...WS.....a48.9.3.......................................... ...................................................................................... ..... E :0 v <br /> ADDRESS ADDRESS - i <br /> ................ .. . ............................................................................ <br /> ......................................................................... ....... ..... I m <br /> PHONE P.HONE <br /> ZD <br /> .......Dma1d..D.Anels................................................... ............................................................................... ..... <br /> PLUMBER WELL DRILLER ✓�� <br /> Vel <br /> y}...................S;ii^6n. ...WS.....54a7.2................ E <br /> RO7� ...................................................................................... ..... <br /> ADDRESS ADDRESS n C <br /> P14'0..N5. ........................................................ .P.riofvE.......................................................................... ..... 'Z N <br /> DESCRIPTION 4. Sanitary Facilities: P c ° <br /> h <br /> Batrooms <br /> 1. Work: 2. New Building Details No. ""' <br /> New BuildingAlp,,, Type of Construction: No. Bedrooms .. ...... <br /> Septic Tank Size Gals. <br /> Addition .......... .................................................... Sep12 0.... <br /> Sanitary ...X..... Size .............. ft. x .............. ft. ... ...... <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: Mou d x `• <br /> Moving .......... Area ........................................... Soil Type ............................. ...... :�• r <br /> Mobile HomeSlope ................................... ...... <br /> .......... y K <br /> Privy .......... 3. Use (describe exactly,'1 -family Perc. Rate ............................ ...... <br /> n <br /> Dry Well m :o <br /> Well .......... home,garage,motel, etc.) "' """ Z 4 <br /> Subdivision Seepage Trench o •m <br /> .......... single...family..................... <br /> Privy --- :w <br /> Camping Unit .......... <br /> .................................................... ' <br /> Seepage Bed <br /> --------------------------- -------- -------- -- j" r Cf ro <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fi . A. .O C <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is located atWX/S' .9 <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersect on. C,, <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o <br /> J to <br /> 5. Lot Size: <br /> Fig. A. 6. Location: :S'-� m fn <br /> ................ ft. x .............. ft. . ............................... sq. ft. <br /> IN O <br /> OJ <br /> J 3 <br /> J � <br /> O <br /> O <br /> 4. <br /> v <br /> T <br /> Z <br /> O <br /> - w d <br /> 7 I = <br /> c 1.N m 0 C m 1D <br /> n mor < J J n — - m <br /> LD. NQ. —' o. m nay <br /> dC0 J3 <br /> O a] m <br /> D -4 <br /> N J N G : A <br /> S c 0, m <br /> �a <br /> ..J ...................................... <br /> � : ....�......... ...�.......................... ... .... /................ v 0 <br /> .. A <br /> ignature of Owner or Agent Date f �: S : <br /> T: 0 : <br /> Remarks a <br /> N <br /> S <br /> .......................................................................................................... ....................... ... .. ............. .. j j � T <br /> 111 � <br /> e <br /> .......... <br /> Inspection Date ....................................... . . . ... ... a o o m <br /> Zoning Administrat S S S $ S tR <br /> NOTE: A preliminary site inspection must be made and site appro I granted on all structures involving sanitary fa ilities 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 bee i 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 AP ROVED. <br />