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Burnett County Office of Zoning Administrator 0 10 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 <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use n e <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> .......................... r� a..Y........................... XTRAAC..CA �Y.. � . ..... n.� � . - y <br /> print) CTOR or SU �OR or AGENT a <br /> �h'..1..-.... �2.0�1 ...1. `an �.i.... . 6 <br /> ...................................... ...................... <br /> ADDRESS - ADORES <br /> fi/ STS.r......�Y�-................... - <br /> P....................:�............................................ . O <br /> ADDRESS ADDRE S 17 <br /> !` .................................... <br /> .....5NI................................................................................. ........................................................ <br /> PHONE PHONE \ <br /> ............... . .................... .................................... ........................................................................................... r <br /> PLUMBER WELL DRILLE <br /> h% Y....................... ........ . .. . .N...s... ....c: _ ... >..... .... <br /> A.......E ./ <br /> ADD fRtSS "� �,/'�,I y� { m L1 ' <br /> �... . c....... l�Y.l.1-:...��'........ —.:... �.� . ... . .. .. r w �L f I �f .... r <br /> .. .... . �' s . . 1�1iTB r......... ......................................... <br /> PHONE5" � PHONE z H <br /> DESCRIPTION d / / Y 4. Sanitary Facilities: ° o ° <br /> th <br /> Barooms <br /> 1. Work: 2. New Building Details No. """"" � o <br /> New Building No. Bedrooms iO T� <br /> ........., Type of Construction: """"" <br /> Addition .................................................... Septic Tank Size Gals. .......... <br /> Sanitary ...... Size .............. ft. x .............. ft. .......... <br /> FillinglGrading .......... Height............. Stories ............... 4a. Absorption Field Site: rj <br /> � i <br /> .............. i r <br /> Moving .......... Area ......................................... Soil Type ...................... `\ <br /> Mobile Home .......... SOP¢ .......................................... 3 0 <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ...................................�11 f <br /> Well home,garage, motel, etc.) Dry Well .......... i <br /> Subdivision Seepage Trench .......... tom`, <br /> Privy .......... <br /> CampingUnit .......... .................................................... I <br /> Seepage Bed ......... <br /> ---------------------------------------------------------------------- <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched in Fig A. Include road R, <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 <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. j. [ o <br /> _______________________________________________ _____ <br /> _ �- <br /> 5. t Size: Fig. A. 6. Location: / <br /> d... ft. x .............. ft. — sq.ft. E <br /> ...... ............................... .................................. ............................................ \. <br /> 11 µ. <br /> N O <br /> O � <br /> (00 <br /> FSP <br /> J <br /> 0 <br /> f <br /> Q� a <br /> Z <br /> 0 <br /> d <br /> L: r 11r, <br /> 01 ,­ M :E d m 2 <br /> m V3 a n <br /> N _. B' E <br /> N 5 M <br /> n m <br /> . > <br /> z o o' a 5 S <br /> o nm 3 <br /> U� 0 <br /> 1•`. n. .•L,.'.`:'�......i/�,/9.,�,.'.,.y,-. `S .• ':�".'............... ,.rr3"(j{........... � � <br /> SISBaWr*- 9wnwAg! / � o <br /> er or no Date <br /> X <br /> Remarks ......................................................................................................................................................................... m m <br /> v <br /> II <br /> ............................................................................................................ . ................. . . ... ................................ . . . . . . T <br /> ° m <br /> Inspection Date ....................................... `! l.l�ni'J'- 9 8 o o o <br /> ndite m <br /> Zoning Administrator : 8 0 $��8 o y <br /> NOTE: A preliminary site inspection must be made asapproval granted on all structures Involving sanitary fallties <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 />