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Burr is County Office of Zoning Administrator Iv ;F <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and O• <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the 7 <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations of;he State of Wisconsin. a <br /> .C�f 4��1 f1.4 5........ �5...`.................................. .......................................................................................... <br /> .. c <br /> OWNER ( ease pntl CONTRACTOR or SURVEYOR or AGENT <br /> le .. . 6x.......1.0 ..1. �R vk ....... . . . . . . . ............................................................................. —a <br /> ADDRESS ADDRESS <br /> ................ <br /> ADDRESS............................................................................ .ADDRESS............................................................ � L <br /> ........... aQ <br /> ........................................................................................... ................................................................................. <br /> PHONE PHONE <br /> ........................................................................................... ............................................................................................ <br /> PLUMBER WELL DRILLER <br /> ........................................................................................... ..A..DD.....R...ES...... <br /> ................... <br /> .......... <br /> ............................................. 0in <br /> ADDRESS S <br /> ........................................................................................... . ................................................................................... O .i <br /> PHONE P..HO....N..E Z N r <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details "-'�"" ° c <br /> New Building ....x. Type of Constructio No. Bedrooms .......... <br /> Addition T ,7 Septic Tank Size Gals. .......... � <br /> .......... .... . . ........ ................. .. <br /> Sanitary .......... Size ....y0.._ ft. ....�.P... ft. .......... <br /> Filling/Grading .......... Height Stories ..../......... 4a. Absorption Field Site: i <br /> Moving .......... Area ......sz�.'XW �3' Soil TYPe .......5 AtO f , <br /> 4. .. .1....... ............... <br /> O <br /> Mobile Home <br /> .......... <br /> Slopen <br /> Privy .......... 3. Use (describe exactly,'1 -family Perc. Rate ................................... <br /> Well ,,........ home,garage �ofDry Well .......... m�QI, etc.) See e Trench <br /> Subdivision a.......... .......:% �1.. ...�/..0..... page .......... o <br /> .... <br /> Camping Unit Privy .......... <br /> ......,-„ <br /> .................................................... Seepage Bed <br /> / ^ <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. g <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is located at <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersection. r N <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. 'I[ <br /> -------------------------------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: <br /> S!o6..... ft. x SS'.`/Sft. - .... ........................ 5q.ft. 5!d.�. 7Y.l..�.R!.!v.....Ocl ....W.��.:�.?.: ie <br /> sw sE sw �rzn1F� <br /> S RCRE's J <br /> � o <br /> ;i <br /> o <br /> Z <br /> z <br /> A <br /> M .N M tprD W d7 -0 <br /> ISOr m Nn� Jsnm anS <br /> O y O m O <br /> ...1.! — ..� —Y o <br /> x <br /> . . .. ......................................... ........................ ...7..... A\ <br /> J <br /> Signa ner or Agent Date c <br /> T : N <br /> Remarks <br /> en. <br /> ........................................................................................................................................................................................ o <br /> .................... . .. ............. <br /> �f� <br /> Inspection Date i��^^-".`.".. ...................... <br /> Zonln ministrator S 8 8 8 <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities before constructit <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 v <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 <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or specifications shall not <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />