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t, <br /> Burnett County Office of Zoning Administrator d o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as 0 o <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use mrZ <br /> Ordinance, Sanitation Code, and with all other <br /> -applicable County Ordinances and thelaw `d regulations of the State of Wisconsin. 3 a <br /> J.�T v o <br /> ............................... .............. ........................... ................................................. N - <br /> a <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a m <br /> ............................................. ............................................................................................ <br /> D ESS ADDRESS ' <br /> .. .. ,!/ s... .. ............................................................................................ <br /> ADDRESS ADDRESS :tl. <br /> asp. y............a.......... ....a� ........ ........... ..................................................................... � <br /> PHONE PHONE '� <br /> ............................................................................................ :\O <br /> ........................................................................................... <br /> PLUMBER WELL DRILLER ' <br /> O <br /> ADDRESS ADDRESS m <br /> 0 0 <br /> ................ <br /> o , <br /> ........................................................................................... . .. ... ............................................................... o' r <br /> .: <br /> PHONE PHONE.. .. ... Z H <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> 1. Work: 2. New Building Details No. Bathrooms .......... 3 0 <br /> New Building .......... Type of Construction: <br /> Addition . .... .........., {.................................................... <br /> Sanitary <br /> .......... Septic Tank Size Gals. .......... <br /> Sanitary Size .....i. ft. x ...UK7.... ft. """"' <br /> f 4a. Absorption Field Site: <br /> Filling/Grading ,,,,,,,,,, Height...�..... Stories ..�......... <br /> Area ............................... ........... Soil Type ...................Moving .......... ................. r i <br /> Mobile Home Slope .......................................... � <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Well .......... ho ,garag mot et 1 r Dry Well .......... uv <br /> Subdivision Seepage Trench .......... <br /> Camping Unit .......... Privy .......... f <br /> ............... .. .............................. Seepage Bed q . <br /> ------------------------ <br /> ---------- �/VN <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig_ A. Include road UV on <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway Inter- LN _ <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. � o <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. . ............................... sq.ft. ............................................................................... �. <br /> i n <br /> N O <br /> o = <br /> _ <br /> I <br /> "bpi Cnsm/ <br /> _ <br /> IPill <br /> � <br /> Ivo ' E <br /> 7a N r � ur Z <br /> m � m <br /> n <br /> Eli <br /> n <br /> on C <br /> 4D� <br /> Z eom <br /> A/ o —_iiim <br /> atu ofOwner or Agte o C <br /> X <br /> Remarks ........................ ............... .............. .... .Ii�„"r"'--_ .. . .. ? p <br /> � � . . ....................... . .... ...... ............................................. <br /> ...................�. ' ..........�r�'�'.�rv"`R....�.��sSeYY.L4'.�... . . .......................f/'�� j . .- <br /> m <br /> \ II <br /> .................,.Q......,../y. ..... ...... ................................. <br /> o : <br /> Inspection Date ....................................... CT!?'rlo / . ./ . ........... ......�...................... o: U o ' U m <br /> . . K 1 � . <br /> Zoning Administrator 8 8 8 8 8 8 rn <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 lie made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />