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Burnett County Office of Zoning Administrator 0 E 0 0 <br /> APPLICATION FOR SANITARY - LAND USE - BUILDING PERMIT 3 <br /> Er TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as r\� <br /> shown herein, The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. a <br /> i \\ <br /> .(Tt lo(l.. d. S .......................... `Svxm �... n../ <br /> a <br /> d <br /> OWNER (please print TRACTOR o SURVEYOR EVOR or AGENT Cu.......... <br /> ' a..�....... �( 5.......................................... <br /> ADDRESS A` Ey.�I+.:C.1.L.IX......!..y^.... +.�..��. Y............ ........ <br /> ADDRESS ADDRESS <br /> PHONE................................................................................ .PHON.E................ <br /> ..... <br /> ................ <br /> .... <br /> ......... <br /> ....... <br /> ....................... <br /> ........................................................................................... . . . ............ '' .................................................................... \ r/ <br /> PLUMBER WELL DRILLER <br /> ........................................................................................... .AD.. DRESS......................................................................................... <br /> ADDRESS m C) <br /> n o <br /> PHONE PHONE Z N r <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms a <br /> N0. Bedrooms o <br /> New Building <br /> .......... Te of Constructiono <br /> m <br /> Addition ,,...,., , Septic Tank Size Gals. .......... <br /> ...................... . ................... .. <br /> Sanitary Size ft. x ft. <br /> .......... .............. ..... ........ <br /> Filling/Grading ,,,,.,,,,, Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area Soil Type .................................... r <br /> Mobile Home .......... Slope .......................................... + <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Well .......... home,garage, motel, etc.) Dry Well .......... <br /> Subdivision ... Seepage Trench .......... <br /> Camping Unit .......... Privy .......... <br /> �d <br /> .................................................... Seepage Bed <br /> ------------------- m <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched in Fig. A- Include road <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property Is located at a highway Inter- n. <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL FXISTING <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. p <br /> --------------------------------------------------- -------------------- Z <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x ............- ft. — ............................... sq.ft. ............................................................................... <br /> 1 0 E <br /> N0 <br /> 0 <br /> � o <br /> v <br /> [� d -o < N Cm_ N <br /> nQ O < N 7 f <br /> m Nan N p m <br /> Z o o' D L <br /> m <br /> o <br /> v <br /> : <br /> Lh p <br /> , ig' ..................................................................... ...................................... �E C <br /> Signature of Owner or Agent Date X <br /> m . m <br /> Remarks .................................................................................................................................................................-........ � � <br /> co <br /> ........................................................................................................................................................................................ — . . . <br /> ...................... ......... ......................................... <br /> O T <br /> Inspection Date .................. .. . l ..^ .. ... ro m `„ Im <br /> ..................... O (li O N O N <br /> ... . .. .... ........ ........... o O O <br /> Zoning AdmI nistr or �,/ $ $ $ 0 0 o y <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 tie 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 it 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 Administratol- <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />