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ON COMPO I <br /> Burnett Coynty Office of Zoning Administrator 9' 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3 As0 <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 La <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 <br /> O <br /> ......r:iz'fes/.......................... ........ ........... .....�... . . ./,,,,,+' ..�..:.........'frGr✓l:orJ............................ c � <br /> OW/N�R (please print CONTRACTOR or SURVEt or AGENT m <br /> 1. � ................5..... .y ..DRESSel�w.....1r/i sY�Y.3........................... <br /> .. <br /> A ES ADDRESS <br /> ADDRESS ADDRESS <br /> ........................................................................................... .P..HONE......................................................................................... b <br /> PHONE <br /> ........................................................................................... .WEL........L...DR.....ILLER...... ..................................................................... <br /> PLUMBER <br /> ........................................................................................... .... ...... .............................................................................. O <br /> ADDRESS ADD.. RES..S m 0 <br /> n o <br /> ........................................................................................... ............................................................................................ o' .: <br /> PHONE PHONE Z h ' <br /> DESCRIPTION r <br /> 4. Sanitary Facilities: P o <br /> 1. Work: No. Bathrooms 'O <br /> 2. New Building Details •���•••••• ' o <br /> ••••••••• <br /> d <br /> Berooms <br /> New Building .......... Type of Construction: No. ' <br /> Addition .......... .................................................... Septic Tank Size Gals. .......... <br /> Sanitary Size ft. x ft. ••• ••• <br /> Pillingf Grading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area Soil Type .................................... o i <br /> Slope .......................................... o <br /> Mobile Home 3 S <br /> y ...I...... 3. Use (describe exactly, 1 -family Perc. Rate ................................... n <br /> Priv •C <br /> Well Dry Well F i <br /> home,garage, motel, etc.) '•••••' •• -+ <br /> Subdivision ,1/,• Seepage Trench R + ` <br /> Camping Unit ....... Privy .......... # i T <br /> .................................................... Seepage Bed .......... <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc.,should be sketched in Fig. A. Include road <br /> Q <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter � 0- <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING C <br /> a <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. p o' <br /> —__ _ -------------------------------------------- i <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... sq.ft. ............................................................................... o � <br /> I J.! n <br /> o o <br /> N, <br /> 2�04 o <br /> na <br /> z <br /> o <br /> X/ <br /> M r- 9 ur W Z <br /> n <br /> EA < m c m <br /> o vNiav F <br /> C •�'c m m '1 <br /> p m <br /> o 7 <br /> D o n <br /> O� a � <br /> _ m < <br /> V o <br /> E\ o <br /> .x� O <br /> N <br /> ........................................................................... y.a - �............ <br /> Signature of Owner or Agent o € <br /> Date <br /> X ] <br /> Remarks ......................................................................................................................................................................... m : n <br /> m <br /> 69 <br /> ........................................................................................................................................................................................ —pp"" : <br /> :cy <br /> Inspection Date /j �, / "' "' ' m ' "H' n <br /> Zoning Admi istrator ki ° 999 8 8 8 0 <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 plumhing 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 Ile made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />