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��'1^GCyyI=J�, <br /> Burnett County Office of Zoning Administrator o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. <br /> o AQ, <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 C .� <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the Sta e of Wisconsin. 3 a 10 <br /> . .... .... .. ...R. L.�.�.Y.�. .......... ...h.:e..../to .........�..�,.f... �1��.s....... - <br /> 0 <br /> O ER (please print) CONTRACTOR or SURVEYOR or AGENT a <br /> X .. 3� �i.i.iSA�!•■Rr.K£..�a..I....PVJ..� .t/�� 'ADDRESS <br /> ........................................................................... y _ <br /> ADDRESS v7 <br /> 1C......................................................................................... . .......................................................................................... <br /> ADDRESS ADDRESS <br /> V <br /> r..�.�.�..-�.g,5,?... ................................................ ............................................................................................ , <br /> ELGINYY PHONE •� :'1� <br /> ......... .. . ......4........ ..............•.......................................... ............................................................................................ <br /> PLUMBER WELL DRILLER ' <br /> . ...... . . ............................................................................... <br /> ADDRESS ADDRESS n o <br /> ti <br /> ........................................................................................... . ................................................. ....................................... o' .: <br /> PHONE PHONE Z r <br /> DESCRIPTION 4. Sanitary <br /> Facilities: o ° 'n <br /> 1. Work: 2. New Building Details No. Bathrooms .... .. a <br /> New Building No. Bedrooms <br /> .......... Type of Co st((uction: <br /> Addition X...,...,d.'.T1. ...,, �/ Septic Tank Size Gals. .......... ;� <br /> Sanitary ,,... Size aQ........ ft. X,'�.y,....... ft. """"" <br /> Filling l Grading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> SA Type .............. ... .. d...... <br /> Moving .......... Area ........................... ............... o .� r <br /> o <br /> Slope .......................................... . 3 <br /> Mobile Home .......... ya IC <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... F <br /> Dry Well '� <br /> Well .......... home,garage, motel, etc.) """"' e^ ;� I ' <br /> .�/l+r.�.B�.N.... .A.S....F....!.!.7......�!. D�p <br /> Seepage Trench .......... a <br /> Subdivision .......... <br /> Camping unit Privy .......... tt <br /> .. / NG /cyi Seepage Bed ..... W- -----------.----------- D ------------------- <br /> N cn <br /> Location of proposed structures and existing structures,well, sewage systems, roads, etc., should be sketched in Fig. A. Include road or <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- U pi <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING J : ��—, <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS t <br /> --- --------------- —__ — ----_ <br /> 5. Lot Size: Fig A. 6. Location: °� E <br /> y ................ f,t,.�/x .............. ft. — ............................... sq.ft. .............................................................................. <br /> ryN <br /> ,SPC Zlwyl cn <br /> m <br /> n <br /> N O <br /> O 7 <br /> O <br /> L O� 04 <br /> 0 <br /> i � s <br /> Z � <br /> 0 <br /> 0 <br /> ID' <br /> 8 � <br /> Z <br /> a tot C <br /> r <' <br /> N. � : < m m <br /> / z oo' n ' 70 <br /> I n <br /> m <br /> Signature of Ow r Agent Date !do . . <br /> 7 � <br /> on m <br /> Remarks ......................................................................................................................................................................... 00 <br /> n : <br /> ........................................................................................................................................................................................ �II : <br /> ............................�...,.�.,.�.�........................................................ .. ..... ...�--6mjnjs�ratc <br /> ..... �g m <br /> Inspection Date ... ................ .................. ..... . . .. ....rator 8 $ 8 8 8 8 en <br /> NOTE: A preliminary site inspection must be made and site<afrp-roval 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 made without approval of the Zoning Adm inistratol . <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />