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Burnett County Office of Zoning Administrator 0 <br /> --1 <br /> o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT a <br /> o � <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as < N 0. <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> ..J.!.!^....... . ... .................................................... .,�—�...L F..................................................... <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT r^ '� <br /> a <br /> f rn <br /> ADDRESS ADDRESS <br /> i ' <br /> ............ <br /> .........................................................................................— . .........R ...ES.................................................................. .. <br /> ADDRESS ! ADDS <br /> .......��5 ....�r..�..P. �6. .��......................................... ............................................................................................ / <br /> PHONE PHONE �(Fy <br /> 9 Ch1 <br /> ................... ............................ <br /> PLUMBER............................................................................ LL D <br /> .WERILL.E.R................... . L <br /> i <br /> ........................................................................................... ............................................................................................ _ <br /> ADDRESS ADDRESS 0 <br /> ........................................................................................... ............................................................................................ o' .: <br /> PHONE PHONE Z ,'� <br /> r <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> s th ........ <br /> Bathrooms . .-d •9 <br /> 1. Work: 2. New Building Details No. \; a 3 <br /> New Building ....' Type of Construction. <br /> No. Bedrooms ......... <br /> Addition ...... Q.F.K... .14.............. Septic Tank Size Gals. .......... <br /> .......... .. <br /> Sanitary .......... Size ....2.Y.j. ft. x .....y L).. ft. .......... <br /> Fillingt Grading •......... Height....`J....... Stories .....L....... 4a. Absorption Field Site: <br /> � # ;l <br /> Moving .......... Area ........ t Soil Type .................................... <br /> �k..... s.y...t.............. o <br /> Mobile Home .......... Slope .......................................... <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ..........................I........ t <br /> Dry Well <br /> Well .......... home,garage, motel, etc.) """"" ' <br /> Subdivision IoL t,,,•S!l,rgy Seepage Trench .......... � i <br /> .......... ........... ...... . ................... <br /> Camping Unit . Privy —....... <br /> .......... ................................................... <br /> V <br /> Seepage Bed <br /> Location of proposed structures and existing structures,well, sewage systems, roads, etc., should be sketched in Fig. A. Include road Q <br /> setback, side and back Yard dimension and location and setback from all bodies of water. If property is located at a highway inter- a <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING ^ a <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. a <br /> ------------------------------------------- --'-- <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... sq. ft. ............................................................................... <br /> 01 <br /> m <br /> N o <br /> 2._ <br /> �ro i2.d Zr der ° <br /> 0 <br /> Lj,�� €g <br /> 0 <br /> NJ C <br /> d <br /> _ <br /> m <br /> �s <br /> S <br /> a cn < G ro <br /> - m <br /> Z C) > a X <br /> o = a a 3 <br /> va = _ <br /> Ch 0 <br /> o �] <br /> a <br /> .�e�... . �.p..,..t../�........... . .:. /Y....8 y o <br /> /mat, <br /> e of Owner or Agent / / Date x <br /> T <br /> m <br /> ........................................................................................................................................................................................ <br /> th <br /> .................................................................................................... ........................ :•U <br /> Inspection Date ....................................... ..... .. .. .... . <br /> ZoningAroQ <br /> T <br /> NOTE: A preliminary site inspection must be made al site approval granted on all structures involving sanitary facllltlLt <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 he made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />