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Burnett County Office of Zoning Administrator d 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 30 <br /> 0 <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as H <br /> AN— <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use V <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin_ 3 a iD) <br /> FRAM K F- NOR I E f <br /> OWNER IPlease print) CONTRACTOR or SURVEYOR or AGENT............................... <br /> R.R... ......... ah.......X079........................................ a <br /> ............................................................................................ <br /> ADRRESS <br /> W <br /> o ADDRESS <br /> ADDRESS <br /> ANB.V..... ...�...w.�s.:.......s!.83Q............... <br /> ADDRESS i its <br /> 1. 715...... a.G,.-..'1.'1 '............................. ............ ............................................................................... <br /> PHONE PHONE C <br /> s l <br /> ........................................................................................... ............................................................................................ <br /> PLUMBER WELL DRILLER <br /> O_ 3 <br /> ADDRESS ADDRESS <br /> n <br /> ........................................................................................... ............................................................................................ p <br /> PHONE PHONE Z <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> 1. Work: y 2. New Building Details No. Bathrooms o <br /> New Building , Type of Construction: No. Bedrooms .......... a <br /> Addition .......... ..... .F({/ J�.7................(tl� ...... Septic Tank Size Gals. .......... <br /> Sanitary .......... Size .....2y.�.. ft. x ...3.0.... ft. .......... <br /> Filling/Grading .......... Height....y....... Stories .............. 4a. Absorption Field Site: <br /> Moving .......... Area Soil Type .................................... r <br /> .......... ope .......................................... <br /> Mobile Home Sl � : ^ <br /> Privy3. Use (describe exactly, 1 family Perc. Rate ................................... <br /> .......... ... c <br /> Well .......... home,garage, motel, etc.) Dry Well ....... <br /> Subdivision6AQAG97 Seepage Trench .......... � i i i <br /> .......... .............................•...................... <br /> Camping Unit .......... Privy .......... <br /> .................................................... <br /> Seepage Bed .......... <br /> -------------------------------------- --- --- <br /> — ------- m <br /> r ?(� <br /> Location of proposed structures and existing structures, well, sewage systems, roads, eta, should be sketched in Fig_ A. Include road f <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 n <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. [ p' <br /> _----------___—_--__—_.--------------------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. - ............................... sq.ft. ............................................................................... <br /> 10 p-CRES <br /> - - 950 <br /> /J <br /> i o <br /> a� a 0 <br /> � t <br /> t 9D 12I I M o Z <br /> J <br /> I `I <br /> dVeR 100 To LO-r LI11E- <br /> Z O D O n <br /> N co <br /> �� pL 7r 4 h.I m <br /> ..........."s^.Qh...!!i.....1............ ................... ...��.!vE....S 198'.. .�... iso c <br /> Signature of Owner or Agent Da4e \� . . . <br /> r � // / qq X <br /> Remarks 6� U/ C1.A ':1..k...... ..�4.a�9 r. T my <br /> . ................................................................................................................ �o : <br /> m : <br /> to <br /> ........................................................................................................................................................................................ 1, - <br /> ............... ...... . .. <br /> t . A.....m....... . ....................................... <br /> Inspection Date ....................................... ... <br /> SSSSSSmoV� d ..... . .. ..�..( Zar .. � <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 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 herie <br /> with Is found to exist. Changes in plans or specifications shall not he made without approval of the Zoning Adm inlstratoi . <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />