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Burnett County Office of Zoning Administrator fC IV 31'_ <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT m ; <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and Yt 0 1 <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 , <br /> regulations of the State of Wiscon 'n. r: G <br /> ..s,..,L;.I�V ......r......... C..� .{.6................. ........................................................................ <br /> OWNER�(plame print) �� CONTRACTOR or SURVEYOR or AGENT <br /> ZL4..�:�.L ................................... ............................................................................................ <br /> A ESS a ADDRESS <br /> 5L J - <br /> 4 r. .u. :. .. ...0 ......................1.....� ......................................................................................... <br /> ADDRESS _ ADDRESS <br /> .............. <br /> :..5... <.....5,1s v...................................... ............................................................................................ <br /> PHONE ............................................................................... WELPHONE <br /> .......... <br /> . . . ..L...D.....RILLER.............................................................. :r... <br /> PLUMBER <br /> ........................................................................................... ..ADDR........ .ESS.S"S" ........................................................................... _. <br /> ADDRESS k <br /> 0 < <br /> ............... G .: <br /> ........................................................................................... ... .. .......................................... ........................ <br /> PHONE PHON.. ..E Z N r V� <br /> DESCRIPTION 4. SanitaryFacilities: P $ » V <br /> 1. Work: 2. New Building Details No. Bathrooms .......... c <br /> Now Building ,..rX. „ Type f Constru ti n: No. Bedrooms .......... <br /> Addition ...... (n(,¢/"... . ............ .... „ Septic Tank Size Gals. .......... <br /> Sanitary Size�.s-J.ye �x ...J.. ft. .......... . <br /> Filling/Grading .......... Height............. Stories ......4....... 4a. Absorption Field Site: <br /> Moving .......... AreaSoil Type .................................... i o <br /> ........................................... <br /> MobileHome Slope .......................................... <br /> .......... .. <br /> Privy .......... 3. Use (describe exactly,*1 -family <br /> Perc. Rate ................................... m <br /> Dry Well <br /> Well .......... home, rage,motel, etc.) '••"""' <br /> Subdivision ,,,,,,,,, ,. Seepage Trench .......... <br /> ' Privy <br /> Camping Unit """"" ' <br /> .......... .. ............. <br /> Seepage Bed .......... : I k., <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. :--� <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is located at <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersection. r <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o <br /> ---------------------------------9-------- <br /> ------------------- <br /> J <br /> 5. Lot Size: FiA. 6. Location: <br /> ................ ft. x .............. ft. — ............................... sq.ft. ............................................................................... <br /> N n <br /> J El <br /> J <br /> g <br /> L O <br /> r �}�� <br /> �o <br /> �. TW <br /> / OT <br /> 71 <br /> W <br /> J <br /> b <br /> yN� <br /> U <br /> Rto <br /> -0N r n ca co -0 <br /> m Na`c —� nm aaS <br /> < d C y J J ; <br /> O V1> N n � <br /> „ a <br /> n o O <br /> �o C <br /> _ J <br /> c <br /> Sign ture of n r or Agent Date o <br /> \ N . <br /> Remarks m n <br /> w <br /> ........................................................................................................................................................................................ �`, . rn : : o <br /> X o <br /> ....................................................................................................... <br /> C ........ .-F .... <br /> Nc W tiu, o yn <br /> Inspection Date ....................................... <br /> Zoning Admini�r for o g g g <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities before constructi n <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 />