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Burnett County Office of Zoning Administrator <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT a <br /> 70 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 U <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 `g <br /> regulations of the State of Wisconsin. » $ <br /> ...................................... ................. ............................ ............................................. m <br /> ............................................... <br /> OWNER (please pri I CONTRACTOR or SURVEYOR or A E T <br /> ..... . ....yr'57... ,� .�/ .s: ..............�- .. .. �' .................. <br /> ADDRESS ADDRESS g pp <br /> jd� ........... .ADDRESS............................................................................ n' <br /> . . <br /> E 'G/..�.F ..........✓r'•.lf..G..../••• .. SIO. PHONE AA <br /> ... r ................................................................................. <br /> .............6.14F........�..�i.A..l�..... ....................................... ............................................................................................ <br /> PLUM R rA/ WELL DRILLER <br /> v, <br /> ... K'r! X� ............................................................................................ <br /> ... - <br /> Nr <br /> AD ..ESS. . ..Y ..`............................................. <br /> ADDRESS 0 o <br /> ......................... . . . ...................................................................................... a ` P <br /> NONE ! 76�1i PHONE Z w r- <br /> DESCRIPTION 4. Sanitary Facilities: ° o o <br /> 1. Work: 2. New Building Details No. Bathrooms .......... c ~ <br /> New Building .......... Type of Construction: No. Bedrooms <br /> Addition ,,,,,,, .•• . . Septic nke Gals. . . •� <br /> .. ....... .................... ................... . <br /> Sanitary Size .............. ft. x .............. ft. oma" :��'itt))) C <br /> Filling/Grading g 4a. Absorptio laid Site: <br /> .......... Height Stones ............... <br /> MovingSoil Type .................................... r <br /> .......... Area ........................... ............. <br /> Mobile HomeSlope .......................................... M n <br /> .......... <br /> Privy .......... 3. Use Idescribe exactly, 1 -family.. Perc. Rate .........................I......... W Dry Well <br /> home,garage, motel,etc.) <br /> Well """"" <br /> .,,,,,,,,, — ' <br /> Subdivision Seepage Trench o <br /> .......... .................................................. <br /> .......... <br /> Camping Unit Privy .......... <br /> Seepage Bed .......... p�� i <br /> ---------------------------------------------------------------------- ^i_. !n _` <br /> i- <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. 1 C <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is located at ;1✓1 F t,�,,\1 <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersection. su <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. 0 <br /> ______________ _____________________ __ <br /> 5. Lot Size: Fig. A. 6. Location: (_} <br /> ................ ft. x .............. ft. . ............................... sq. ft. ............................................................................... <br /> C0 <br /> o' <br /> o J <br /> J. �J <br /> O <br /> 0 <br /> 0v <br /> J <br /> m Na.<c ''— nmCo <br /> nny <br /> p m b <br /> Z.-•O D ' <br /> �J ma <br /> a : MI <br /> A <br /> m <br /> ............ ... ...............Lw!! %!.........:- � ��......... ....6...•-�...../.a O — <br /> _ 9 <br /> Signatur caner or Agent Date 8 G <br /> N <br /> Remarks mP_ <br /> N <br /> ..........1.... ...... <br /> N O N N m <br /> Inspection Date ....................................... ......................... 4nginistrator <br /> . . . ............ .... u, v, u, o o v, m <br /> n8 88 89 8 N <br /> NOTE: A preliminary site inspection must be made and site approval granted o all structures involving sanitary facilities 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 />