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Burnett County Office of Zoning Administrator 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> e J <br /> TO THE ZONING ADMINISTRATORThe 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 •n, <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 cu �+ <br /> �..4.r..�... . . ......!.l...k....S:/��!�°l.v.S�.i .......... . ......................... ................................................................ _ '� 0 <br /> a <br /> a <br /> OWNER (pleas print) ��\ <br /> /fin .•} CONTRACTOR or SURVEYOR or AGENT o. <br /> .....••I ...l..........I............ <br /> 4..�S. N../.�.y ADDRESS............................................................................ <br /> ADDRESS r <br /> a..s..Y:..-......3..a...v... ................................. <br /> ADDRESS ............................................................................................ <br /> ADDRESS S <br /> ................................ ............................... �! <br /> PHNE ........................... rill;.......................................................................................... \ <br /> PHONE <br /> 15.... ..... !.. v.�l...J:............................................... ...........................I..................... <br /> PLUMBER WEL.................................... <br /> WELL DRILLER <br /> ........................................................................................... .ADDRESS............4..`...I. ..............................................4....... <br /> ADDRESS " " ' <br /> P.H.O..N.E. . <br /> .p <br /> ........ . . . ..................................... <br /> PHONE + <br /> : <br /> DESCRIPTION 4. Sanitary Facilities: P $ <br /> 1. Work: 2. New Building Details No. Bathrooms <br /> New Building Type of ConstrueNon:. No. Bedrooms �X''' �.... �� -°o 't^ <br /> Addition ., Septic Tank Size Gals. . ..... <br /> Sanitary .•/a.... Size .............. ft. x .............. ft. ........ . <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: Q\ <br /> Moving .......... Area .............4........................ .... Soil Type ............4....................... ;e <br /> Mobile Home Slope.......................................... 3 <br /> 15 <br /> Privy .......... 3. Use (describe exact) , 1 -fartil Perc. Rate ................................. . F c� <br /> Well .. ....... home,garage, motel,e Dry Well M '1o. <br /> Subdivision <br /> Seepage Trench .......... <br /> Camping Unit .......... .................................................... Privy IIA <br /> p' <br /> _______________________ ............................................. �/• <br /> Seepage Bed p,^...�rk N :� �� <br /> ______________ r <br /> Location of proposed structures and existing structures,well,sewage systems, roads, etc., 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 <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING �"1 i� 5 <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. re <br /> 0 0' <br /> ------------------------ ------ <br /> . Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... sq.ft. ............................................................................... o b <br /> O <br /> N S p' <br /> o <br /> o <br /> y s <br /> T <br /> Z <br /> o <br /> m <br /> a <br /> : U <br /> 37 N ma Zl <br /> 4 •�c E <br /> a (Nnam c � <br /> 0 0? qma <br /> n <br /> � o <br /> ...... t ...................... . ................................... ........ .. ..... � <br /> C_ <br /> Signature of Owner or gent Date o <br /> Remarks ` x . . . : 7g <br /> ........................................................................................................................................................................ m <br /> ........................................................................................................................................................................... ' <br /> v <br /> .........................................................................4.................. . �i <br /> .I <br /> Inspection Date ............4.......................... i a: j . , <br /> c ro ca ro m <br /> $ <br /> T O N O N <br /> Zoning Admi �� � 8 g g g g y <br /> NOTE: q 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 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 /> �r r � <br /> Je �FFi �F 331,1 <br />