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I C / C. . •� L� ` <br /> Burnett County Office of Zoning Administ ator I? c <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 y <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work describe and <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements f the <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the law and <br /> regulations of the State of Wisconsin. <br /> {'/_`.'t71 ..........n/. .... i .l.. .h:n!................. . ................................................................................. ........ <br /> 6Wi- 4- pri )t J ,p CONTRACTOR or SURVEYOR or AGENT <br /> ............................. ................................................................................... ........ <br /> ADDRESS ADDRESS m •� <br /> ...'S.,'�O)61VOI�5x................#:�K...... ... ................................................................................... ........ <br /> ADDRESS ADDRESS <br /> :v <br /> PHONE................................................................................ .PHONE....................................................................... ........ t <br /> . s'...-..a.v� <br /> PQ: <br /> / <br /> • l : <br /> c>C <br /> PLUMBER WELL DRILLER <br /> ................................................................................... ....... ......... . ..................................................................... ........ <br /> ADDRESS � . <br /> AODR..ESS.. • <br /> o <br /> ........................................................................................... c <br /> m <br /> PHONE PHONE Z « � <br /> DESCRIPTION <br /> 4. Sa itary Facilities: j c o » <br /> 1. Work: 2. New Building Details No. X <br /> s <br /> ........ i c <br /> Now Building ,,......,, Type of Con truction: No. B . ........ $ <br /> Addition r AM Septiize G s. . ........ <br /> .......... ........... ..........4................ .. i <br /> Sanitary .......... Size ....1A.... ft. x ..:: `�... ft. . ........FIIIInglGrading ...... Height...D..... Stories .....1....... 4a. Absod Site:Moving .......... Area ........................................... Soil ....... ............. ........Mobile Home .......... Slope ............ ........ ........Privy .......... 3. Use (describe exactly,'1 -family Perc. ................. . ........Well .......... home,garage, motel,etc.) Dry . ........ = i <br /> 1� Z <br /> Subdivision ...A..rAd ...... Q..... .I.T.�n� S Page Trench . .... .. o <br /> .......... <br /> Camping Unit .......... nvy • ` j , <br /> .................................................... <br /> eepage Bed . ........ <br /> ------- ---------------------------- -- <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in F g. A. c <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is loca ed at U) 9 <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersection. r, „`—, <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o <br /> 5. Lot Size: /CO �, WS Fig. A. 6. Location: <br /> ................ ft. x .............. ft. . sq. ft. ..................................................................... ......... <br /> PoLEScook 0 <br /> ,I,D,dN, A)Of E-IIRLNEt o 0 <br /> 0 <br /> v <br /> Z <br /> 0 <br /> p <br /> El _' <br /> i M1 a V U) r- Da m <br /> „UO o (n cr <<" > > o E E 1t1 <br /> T N o.� - C m a n <br /> y 5 5 3 <br /> G <br /> OHO .2 D - <br /> Ute ya ' <br /> L.. c o m <br /> ..... .. ✓/Y.�SA(�.... .. ./ ...................................... x f, RI <br /> Signature of ner/drAgent Date 'o <br /> ,y o . <br /> Remarks ......................................................./..: .P ........"-P�. ............................................................................. ..... i. n <br /> .................................................................................................................................................................................. ..... <br /> ti N <br /> O ' O <br /> .................................................................. . . . <br /> Inspection Date ?L?� � ��?GP.�... � ....... . K) W " o m <br /> ... .................... ... <br /> ....................................... ................ . . .. ... . <br /> Zoning Administ/ or 13'! $ $ $ $ $ y <br /> NOTE: A preliminary site inspection must be made and site ap roval granted on all structures involving sanitary facilities before constructs <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this appl cation before a permit will <br /> be issued. Do not purchase or install a septic tank, do any plumbing or start any building until a permit has beet issued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or pecifications shall not be <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />