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Burnett County Office of Zoning Administrator 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT a 3 0 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m :Q <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 <br /> - d o <br /> OWNER (please print) CONTRACTOR or SURV EVOR or AGENT <br /> . . l...g <br /> ......3.i........�� ... . .ADR. S............................................................................ <br /> DDRESS .. .. ...... o. <br /> r` <br /> :C <br /> •b•�•64.�r...�...M.l�t.........�..Y...!. .r....rl,.`.�j./r�ly R �? <br /> ........................ <br /> ADDRESS <br /> a - �217................................................ ............................................................................................ <br /> PHONE <br /> .......... <br /> .. .......... .... ... .. <br /> ONE . . . . . S <br /> ........ . ..... .... ............................................................. <br /> .............. .......... ................. ........................ ....... . <br /> PLUMBER WE.. ..LL DRI.... LLE.. R <br /> O <br /> .......... <br /> . . . .............................................................................. ...A.DD.....R..ES....................................................................... _. <br /> ADDRESS S <br /> < <br /> o <br /> ........................................................................................... ... ..................................................................................... � <br /> PHONE PHO....NE Z r <br /> DESCRIPTION 4. Sanitary Facilities: o 0 o A <br /> 1. Work: 2. New Building Details No. Bathrooms .......... o <br /> New Building ,.....,,,, Type of Construction: No. Bedrooms .......... <br /> 36 <br /> Addition .......... .................................................... Septic Tank Size Gals. .......... <br /> Sanitary .......... Size .............. ft. x .............. ft. .......... <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: P: <br /> Moving .......... Area Soil Type .................................... <br /> ........................................... Slope .......................................... <br /> Mobile Home .......... <br /> Privy .......... 3. Use (describe exactly, 1 -family <br /> Perc. Rate ................................... t{ •f0 <br /> Well Dry Well �. <br /> home,garage, motel, etc.) """"" <br /> Seepage Trench t ' <br /> Subdivision .......... ......................I.............................- y .......... N t <br /> Camping Unit ,,,,,,,,,, Priv .......... 4 .0 D <br /> .................................................... Seepage Bed 'V <br /> .......... <br /> Location of proposed structures and existing structures well,sewage systems, roads,etc., should be sketched in Fig. A. Include road pl <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter _, W .� <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING W .� a <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. D o <br /> ---------------------------------------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: <br /> 3................ ft. x .............. ft. — ............................... sq.ft. ............................................................................... <br /> �\ <br /> ( 6 month period) ,] ; M <br /> Application for land use 1 /� 0 <br /> Camping permit from ---�1L� �l-�R�b ---- to "-may-/-J� b------ 0 <br /> C <br /> 0 <br /> o <br /> I � <br /> � H <br /> T W <br /> Z <br /> o <br /> r a <br /> `:C J <br /> c <br /> •m to Z <br /> fNTla Cc 'D <br /> m : � m _. m <br /> Z o o D a <br /> o <br /> tom/ /i./'J�/-_ yyy�iwvrl o a ' -1 <br /> tom/ m <br /> ................ ........T� 4.JK... '\o c : C <br /> Signature of Owner or Agent Da t <br /> �1 D X <br /> y1 // ...... `.. /�y.7............................................ M a : v <br /> M <br /> ........................................................................................................................................................................................ u <br /> II <br /> ....................................................................................................... ....... ................ .. ................................................ t�, T <br /> Inspection Date ....................................... .. G�L.Ir.%( - ........ i �."�u o o �' m <br /> Zoning A nistrator 8 8 8 8 8 to <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 be marle without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />