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Burnett County Office of Zoning Administrator c 1 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 0 <br /> 0 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < H � <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 State of Wisconsin. _ a <br /> 7 S od... . �,- <br /> m .� d yo <br /> OWNER paaase print) CONTRACTOR or SURVEYOR or AGENT a <br /> l !........./. ....�i/s�2seh....Gv�. s........... ............................................................................ . <br /> ADDRESS ADDRESS <br /> .../Y..B ?:.................�i�y3.............. <br /> ... . ..................................................................................... . . <br /> ADDRESS ADDRESS ti0 <br /> 3-.SG.. ...'....?5.y./............................ ............................................................................................ <br /> Al <br /> PHONE PHONE <br /> ........................................................................................... <br /> ............................................................................................ <br /> PLUMBER WELL DRILLER <br /> O T <br /> ........................................................................................... .A........................................................................................... <br /> _. :i' <br /> ADDRESS DDRESS m 0 <br /> 0 o <br /> ..................................................................—....................... ................................................... ....................................... i o' �_ <br /> PHONE PHONE Z h r <br /> DESCRIPTION 4. SanitaryFacilities: C? ° o ° <br /> 1. Work: _ 2. New Building Details No. Bath <br /> rlo(q�9 'j .......... 3 o <br /> New Building ,...., ,,, Type of struction: No. Bedrl .......... s i E <br /> Addition �{.,. „•, Septic Ta Si Gals. ......... <br /> ... . . ... .//.. ..... ..... .......... <br /> Sanitary .......... Size ...,t.tR..... ft. x .../...�...... ft. .......... i <br /> Filling/Grading ,,,,,,,,,, Height............ S>bojies .... .......... 4a. Absorption Field Site: <br /> Moving Soil Type .... ...................... r <br /> .......... Area ........�..`fa2........................ .... C(: <br /> Mobile Home -„ ,,,,,,- SIOpe ...... . ... .. .. + <br /> o <br /> Privy 3. Use (describe exactly, 1 -family Perc. Rat ................4...... & <br /> Well home,garage, mote etc.) ”"""" <br /> Dry We <br /> Subdivision ,3 Q,SON vOYh Seepa Trench .......... N <br /> .......... . .........}. N <br /> Camping Unit .......... •... P.CilC......... ................... Privy .......... <br /> .......................................... Seepage Bed ..........---------------------------------------------------------------------- <br /> t J <br /> E Vn i <br /> Location of proposed structures and existing structures,well,sewage systems, roads etc., should be sketched in Fig A. Include road C <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- air <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS.---------------------------------------------------------------------- <br /> o H Y <br /> O j <br /> 5. Lot Si : 3� Fig. A. 6. Location: `-' <br /> ..�..../..... ft. x .............. ft. — ..c3 ......... sq. ft. ............................................................................... <br /> � <br /> n <br /> N iS <br /> o <br /> O <br /> - See <br /> ,gP�alicafior O <br /> d <br /> 7J N r- 9 N to Z <br /> n Q 0 < m c m <br /> m _ <br /> - � - m <br /> Z O J D a <br /> o <br /> zp -4� s . �_ <br /> O <br /> m <br /> Ignature of Owner or Agent G ateo C <br /> X : 37 <br /> Remarks ......................................................................................................................................................................... In m <br /> v <br /> ........................................................................................................................................................................................ <br /> :o . <br /> ............................................................................................................ ... .............. ..... ... . :to <br /> �: « m <br /> Inspection Date ....................................... .. .. .. .... .... ............ ............................. N N m <br /> fnu o ov <br /> Zoning Ad strator 8 8 8 8 8 fn <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving Sanitary facile ies <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 tte made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />