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Burnett County Office of Zoning Administra or 3 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d <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 t fJC� <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws nd 3 � ` <br /> regulations of the St'atteof WWisconnsself <br /> y/�/y� <br /> ........................................................................................... ...................................................................................... ..... <br /> OWNER (Please rmtf CONTRACTOR or SURVEYOR or AGENT <br /> f �.... x,.......... ...ae............................... . . . . . .......................................................................... ..... <br /> ADDRESS ADDRESS m, <br /> _SSO ... .......................................................................... ...... E <br /> AA................................... ..................................................... <br /> ADDRE ADDRESS <br /> X30...-.. o . ........................................... . ................................................................................... ...... <br /> PHONEPH0NE <br /> . . .............................................................................. ...... <br /> ........................................................................................... .WELL DRILLER �f <br /> PLUMBER ' <br /> O \\� <br /> . . . . . ................................................................................... ...... _. V <br /> ..... . . . ............................................................................... ADDRESS <br /> ADDRESS n <br /> O................................................................................... ...... <br /> PHONE PHONE 2. o : <br /> DESCRIPTION <br /> 4. Sanitary Facilities: c o <br /> No. Bathrooms •••. •O <br /> 1. Work: 2. New Building Details 0 <br /> New Building .. Type of Construction: No. Bedrooms •- • <br /> Septic Tank Size Gals. .... <br /> `' y .. ....... <br /> Sanitary ...... Size ....7�.... ft. x ....7.. . .. ft. <br /> •••• } 4a. Absorption Field Site: <br /> Filling/Grading .......... Height...Q........ Stories ...�......... <br /> Soil Type ........................ ... ....... i r <br /> Moving .......... Area ........................................... o <br /> Slope . ................... ... ....... <br /> Mobile Home ... ate ..... ^ <br /> Privy •.. 3. Use (describe exactly, 1 -family <br /> Perc. Rate ........................... ....... m <br /> Well home,garage, motel, etc.) Dry Well • ....... Z <br /> Seepage TrenchR' <br /> ....... <br /> --SuDOlvlelon-- .......... ........ .. r . . <br /> I `f .. ...... Priv . ....... <br /> Camping Unit ....... ...... y <br /> Seepage Bed <br /> -------------- -----_ __ rA <br /> C <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. <br /> _ <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is loca ed at Ni'w i <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. ;O 0 <br /> ----------------------------------------------- <br /> 5. Lot Size: 9 -- -- <br /> Fi A. 6. Location: t <br /> ................ ft. x .............. ft. — ............................... sq. ft. .................... ................................................ ......... <br /> N O <br /> O <br /> J M <br /> T J <br /> y O <br /> z <br /> C� P <br /> D <br /> m <br /> m m > m m -0 <br /> o = < _ 0s. _. m <br /> O N N o IO 00 <br /> Zy^ro .2D ; <br /> J m n <br /> n : y <br /> $ 2 m <br /> 0 : O <br /> � <br /> a <br /> y � ls - <br /> . ......... .... ... ... .. Dat <br /> c <br /> A . <br /> S:.. . .r f Owner or Agent <br /> o , <br /> T H <br /> m a ' <br /> Remarks ................................................................................................................................................................. ....... <br /> w. w <br /> ................................................................................ ..... .................. . ... ! !' <br /> 0 0 <br /> o ' <br /> .. .. Mn <br /> Inspection Date ....................................... <br /> ......... ..... . / <br /> ..... . . . ....... .. Vit/ ........ ....... o m <br /> Zoning Admin is for 8 0 8 g o <br /> NOTE: A preliminary site inspection must be made and site appy at <br /> granted on all structures involving sanitary acilities 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 />