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c- , <br /> Burnett County Office of Zoning Administrator d T o 2 <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 ] k <br /> 0 <br /> Shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use c <br /> 9 9 <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the lawand regulations of the St a e of Wisconsin. a <br /> ...."........y...... ... ................................SfN/� 5�/Cy✓.. <br /> . ........ <br /> .... ........�...................... _ac <br /> �% <br /> TRATORoSURVEYORor NT <br /> OWNER (Please Print) ............................ <br /> CO <br /> ADDRESS C............... .Q.X............./ <br /> ADDRESS <br /> .................�� e.�.! yaoD..... . 2<. 7Jl..AD / / . ...... ° <br /> ^ <br /> O <br /> � �...5 <br /> �. <br /> Cl. ..-.. .�1..... .9..//0............................ �- /3. . <br /> PHONE ...... ......... .......... ....... .. .. ......................................... <br /> ��//// // PHONE yy :- <br /> PL.EIJ. EFal .l.. .............................................................. J Y �jC..... <br /> U BER . . ..... ........................................................ <br /> WELL DRILLER <br /> .....................................................................I......I.............. . . ...... . ............................................................................... p <br /> ADDRESS ADDRESS — <br /> PHONE . . ...................... .n_r <br /> 0 <br /> .............................................. ............... .................................................... .PHONE o <br /> �: l ~ <br /> DESCRIPTION es: o <br /> 4. Sanitary Facilities: o <br /> 1. Work: : A <br /> 2. New Building Details No. Bathrooms <br /> New Building Type of orptruction: No. Bedrooms ` o t <br /> d <br /> Addition ,,y p ✓ yr,e_ .......... m <br /> .,/�.... ...(.[J .. ............1C....A......... .. Septic Tank Size Gals. .......... �; <br /> Sanitary .� <br /> Size ..1. ...r. ft. x . ..y... ft. .......... <br /> Filling/Grading Height.......... <br /> St ies .../........ 4a. Absorption Field Site: <br /> .......... <br /> Moving Area ...... .�j,- !/ Soil Type .................................... <br /> .......... ..... . r <br /> Mobile Home Slope .......................................... '� •° <br /> .......... <br /> Privy ,,,,,...,, 3. Use (describe exactly, i -family Perc. Rate ................................... ?� <br /> Well .......... home ara4 e �mg6el, etc.) Dry Well <br /> Subdivision <br /> .. ....... <br /> )i Seepage Trench <br /> Camping UnitPrivy <br /> -- <br /> (� <br /> I <br /> _____—________________________ Seepage Bed .......... <br /> Location proposed structures and existing structures, well <br /> setback, sidid , sewage syste _____e and back yard dimension and location and ms, roads, etc., should be sketched in Fig A. Include roadsetback 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 , i� <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> ----------------------------------------------------- ---_—._--__--_ <br /> 5. Lot Size: 22 Fig. A. 6. Location: <br /> ...I............ ft. x ..VD.../ ft. — .... /U <br /> O G tiL... .... ........ sq.ft. / / \ <br /> J � R <br /> to l � c a <br /> N o <br /> 0 <br /> u <br /> o . <br /> �o aux 3so <br /> 3 o <br /> a N,. <br /> :n <br /> syf'c <br /> n r v o m <br /> a cn Z . �' M <br /> Z o N ' m m <br /> 5�. n -M <br /> o � a 3 <br /> �... .. .. p <br /> �... . . ......... .. MM <br /> Signature of Owner or.Age t /4 Date E : : C_ <br /> Remarks ............................................ X <br /> ........... m <br /> O <br /> u <br /> Inspection Date ....................................... .,�.?f?/-o �.. " ...'J, <br /> .. `i U o M o U m <br /> ........ ...... <br /> Zoning Adminlstrator K J g g g g g g y <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 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 marle without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />