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Burnett County Office of Zoning Administratord 0 0 <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 '� h 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 e <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> ?.o.s.. ..........P.. .p.. .R.; N. <br /> OWNER (Please print) CONTRACTOR or SURVEYOR or AGENT <br /> RT .....8aX3. .9.....[�..4A <br /> . <br /> �!.T..s.C34RF�.WLS V . ............................................................................................ <br /> ADDRESS LN3y '7 ri5 � ADDRESS <br /> IY.AR.[,! ARN..Ti . <br /> . <br /> . <br /> . <br /> . <br /> . <br /> . <br /> . . <br /> ... . ... <br /> ADDRESS .............................................................. <br /> A .............. <br /> DDRESS <br /> ..................S.la...'! . .5. 5....... ..... . . . <br /> ................................................................................. <br /> PHONE PHONE .' <br /> .WEL.......L..DRI.... ............................................................................. <br /> PLUMBER LLER <br /> ........................................................................................... . ................................... .. <br /> .. ............................................... O <br /> ADDRESS ADD.... RESS �' C) <br /> o <br /> ..........................................................................—.............. . ......NE.................................................................................... O ,� <br /> PHONE PHON <br /> DESCRIPTION o '- <br /> 4. Sanitary Facilities: o ° <br /> 1. Work: 2. New Building Details No. Bathrooms ........,. -p <br /> New Building 4,Q AGt Type of Construction: No. Bedrooms ........ . rip <br /> ' <br /> :(11Addition .Wo.vp. FRAM � Septic Tank Size Gals, <br /> ,....,,... ........ ......... ,, <br /> Sanitary .......... Size ... qq <br /> ft4 x ft. .......... <br /> Filling/Grading Height............. Stories .....I......... 4a. Absorption Field Site: i <br /> Moving .......... Area ............ Soil Type ..........................I......... <br /> o <br /> Mobile Home .......... Slope .......................................... .. <br /> Privy Perc. Rate ................................... O E <br /> .......... 3. Use (describe exactly, 1 -family <br /> Well ., ,,,,,,, home,garage, motel, etc.) Dry Well .......... <br /> Subdivision Seepage Trench ................ q� ... <br /> Camping Unit PrivY.......... .... '�; <br /> .......... <br /> .................................................... Seepage Bed <br /> .......... In <br /> ------------------- <br /> Location of _ --------------------------------------- 'c <br /> 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- _a <br /> section, show the Intersecting highways and the setbacks required along them and at the intersection- CLEARLY LABEL EXISTING i <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> Q o' <br /> 5. Lot Size: Fig. A. 6. Location: <br /> n <br /> ft. x .............. ft. — .Q,.a�1./.!t!............. sq. ft. 45AAAT.H....9.Y.....Mcs dt <br /> U <br /> 3 <br /> ,V cI <br /> � s <br /> / ! N _ <br /> , 14 O o <br /> A <br /> y <br /> V 9 r44t o e <br /> w <br /> act's :�. o <br /> Q <br /> a� 0 <br /> c o <br /> rr <br /> 2o;2ry sq.Fr <br /> Owrtr+,n R/lv <br /> / a <br /> rg- <br /> SCuI e. <br /> fA ¢ F <br /> N Na C < d 6 m <br /> Z 00' � D n <br /> d j 71 <br /> cn <br /> ON o 1 <br /> ..... - <br /> p- ,.............. <br /> Agent....... /�^ �g�.s.�..�.9.g ... <br /> Signature of Owner or AgeDate ° C_ <br /> ��11 X . . . . . <br /> Remarks ..1. Xe'X ... 0a 7,s f on m <br /> ........................................................................................................................................................................................ <br /> n <br /> 1 <br /> Inspection Date ....................................... �' 0 o N o u <br /> . m <br /> /.�•J... ... . . . . . . .......... : o <br /> M <br /> Zoning Ad lstrator 8 8 8 8 o e in <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facil itir;s <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 />