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Burnett County Office of Zoning Administrator u o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3 <br /> o <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as v, <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use T c { <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 n 4, <br /> I�quacl� c �lJor2Rrs t it � 4-4Jrq�ks - 0 <br /> ....... <br /> ..... ............. ........ .. ...... ...... <br /> . .... ......................................................... <br /> .....:................................. � � \ <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT o. <br /> 4 4 4o A <br /> .. . .................. ... . . ... . ............ ............................................... <br /> ADDRESS ADDRESS <br /> M <br /> ...l.s.. ...M. ....S.S ......8........................... ............................................................................ a ': <br /> ADDRESS ADDRESS i <br /> . ?..?. ....�z7..-.�. .�.................................. .................................................... <br /> PHONE PHONE <br /> ........................................................................................... ............................................................................................ <br /> PLUMBER WELL DRILLER v <br /> O <br /> .......... <br /> ........................................................................................... ........................................................................... ...... _. :! <br /> ADDRESS ADDRESS m L7 <br /> cc < <br /> ..................................................................4........................ ...................................................Y....................................... p o' .` <br /> PHONE PHONE Z � 1\U <br /> DESCRIPTION 4. Sanitar Facilities: ° o ° <br /> No. Bathrooms v i <br /> 1. Work: 2. New Building Details ••'•""" o p�� <br /> X No. Bedrooms a <br /> New Building ,,,X,,,, Type of Construction: """"" m <br /> Lc) Septic Tank Size Gals. .......... <br /> Addition ....... .. < ' <br /> ............................ ....... <br /> Sanitary .......... Size ....t�..... ft. x ....... .. ft. "."""' <br /> Filling/Grading .......... Height..t.-Z .. Stories ..4!P ... 4a. Absorption Field Site: . <br /> Moving .......... Area ........Sk .............. Soil Type .................................... i r <br /> ............... ..... <br /> ; <br /> MobileHome Slope .......................................... <br /> Privy . 3. Use (describe exactly, 1 "family Pere. Rate ................................... "I <br /> x <br /> Well .,,,x„ home,garage, mot 1, etc.) Dry Well .......... <br /> Subdivision E!d@Q.l( CQ IAtl:vr Seepage Trench .......... <br /> Camping Unit .......... .................................................... Privy .......... <br /> Seepage Bed .......... p <br /> ----------------------------- I i rn i <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched in Fig. A. Include roadon <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. o <br /> ------------------------------------------------ --------------------- <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... sq.ft. ............................................................................... <br /> kc <br /> P.-m7c 3q acrtS <br /> I52o o o. <br /> o O <br /> 0 <br /> tj <br /> Vim-- 3� Cy" Z <br /> O <br /> Rp/ d <br /> M <br /> e <br /> D vrrv � � m <br /> 3i o 0N. m : � Da, <br /> Z n <br /> to 3 <br /> 1 ) o <br /> LQke— <br /> v� m <br /> Signature of Owner or �nt� Date � <br /> Age <br /> Remarks ........... .Q.....�t`.:►"..T'�!--...... 7...... .......................... d �Zw.rA x m <br /> ��s � ��................................ .................. m <br /> ......................... L4 ��.J...:.1. I16:1 y... n tJ �d..L v�?f:? ::.�i..:. ^.. <br /> G : <br /> Inspection Date ....................................... ... .�t� :?..M .... Z�' _ a1z�.............. o 0 o 0, 'o m <br /> Zoning Admmistrof or ,r' V 8 8 8 8 8 8 y <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilltius <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 />