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Burnett County Office of Zoning Administrator a o z <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as < ~ o <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 Slate of Wisconsin. 3 a <br /> rF <br /> '.v.. .a...or�........ 0...�:-.u.z� � <br /> . ........ ..... . . ... <br /> � ................ crr e <br /> � ,OWNER (please print) ! 01G1 05/ 9 <br /> �z" ���'°° ��u rA't NTRACTOR or SURVEYOR or AGENT a � <br /> p's.Q.........� ..........N .. .:. .:.......J.'�I.l..!1:.7.... .ADDRESS............................................................................ d Q-- <br /> Wm(bjt �Y — `✓ <br /> l�.........(L7/li /.drS..�l.U. l........lt/Z 4G{........... .......................................................................I.................... : 1 <br /> ADDRESS / L Rib!n ADDRESS 1 <br /> ,t/rn ...bl. .- .......... <br /> .. . <br /> ... S .X ........................................................................................... <br /> PHO�.NE PHONE <br /> /t/.Q. 4...'................................................... . ............................ �?.v?s�' ....................................... <br /> PLUMBER WELL DRILLER <br /> ........................... .-......................................................... . ................................... <br /> ...�.............. <br /> .... <br /> ............................. � ' <br /> ADDRESS ADDRESS `-- <br /> n o :1 <br /> ...................................................................... <br /> — ........ <br /> ..—.... <br /> .PHONE................................................................................ _. < <br /> PHONE <br /> DESCRIPTION o r <br /> 4. Sanitary Facilities: o ° <br /> 1. Work: No. Bathrooms i <br /> 2. New Building Details .......... <br /> _ o <br /> New building ✓ rei},e(1,0.� Type of nstruction: No. Bedrooms .�� ? <br /> Addition ••••%,.• ,..„ ••••, /L•!4•//J.............r....... Septic Tank Size Gals. I <br /> Sanitary .......... Size .... ft. X .....'4..f7... ft. .......... <br /> Filling/Grading ,, ......• Height............. S�tories ..../......... 4a. Absorption Field Site: iQ .'• <br /> Moving .......... Area ........ Soil Type .................................... :z ' <br /> r <br /> Mobile Home .......... dp Slope .......................................... ., <br /> o <br /> Privy .......... 3. Use (describe exactly, i -family Perc. Rate ................................... C) <br /> Well home garage motel, etc.l Dry Well .......... <br /> .......... <br /> Subdivision .....••.. Seepage Trench .......... <br /> Camping Unit �j�p/r Privy <br /> ......... �.1.�'!"71:.1 ............ Seepage Bed <br /> ------------------------------------------------------------------ N <br /> Location of proposed structures and existing structures, well, sewage systems, roads, eta, 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- I a <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING 111 <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. — <br /> --------------- . <br /> -------------------------------- <br /> _ � o <br /> �o�lv T 7�cr�t ---------- <br /> 5. t Size: Fig. A. 6. Loco ion: :� <br /> 6,0..nr4re G��/G:! 1fu. .t�.......lG�Via ..:-.... I. d�2 <br /> ..... ft. x .............. ft. — ............................... sq.ft. <br /> Fri > , . T <br /> 0 <br /> ��` 't / 0 <br /> z t� <br /> o <br /> �✓� 7"r ” 30 <br /> 0 <br /> { <br /> 69er <br /> C <br /> t; L- . <br /> ee J] N r m m Z <br /> C <br /> 2; N_ t c m <br /> c: m a W <br /> 6Uer- e4cls-6 fl 'Spa( <br /> Tv' � L p � o� m � � a 5 � <br /> C. <br /> - ......... 'L.. <br /> p <br /> ....... =........ 9- � <br /> ... .. . . r <br /> Signature of Owner or ent Date. .81... .. o <br /> J — _ <br /> Remarks . ....... X <br /> lQ........ .... �...�G«, .......E zf.................................................... m <br /> ................................... <br /> '.... . Cr....... ✓r lc .......... .................................— v <br /> ' ................................................... — <br /> ...................................... .................................................................... .... ............... .. .......................................... <br /> Inspection Date ....................................... <br /> .................. .. ........... ...... <br /> Zoning Administrator i 6; 0 C 0 0 0 2n <br /> NOTE: A prelirn inarq site inspection must be made and site approval granted on all structures involving sanitary facllitini <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 Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />