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Burnett County Office of Zoning Administrator d o Z <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. <br /> o <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 m ?� <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> 5y/� n� V Bob- s <br /> ../ 00 <br /> .................................... ..............................5 P./............................................... o <br /> ....... ........... .. _ <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT m <br /> o. U i <br /> /.1...3/..1 .........<...q. ,.4....w.�...e..d.......G(....... .......... — a <br /> .................................................................................. d <br /> ADDRESS ADDRESS .. ' <br /> 44 <br /> Prate <br /> ...��...n...............................................' .�h. .A• .....5........�...`�. ........................................................ <br /> ADDRESS ADDRESS I? <br /> .�. .".....y.�l3.r... ............................ <br /> ....................................................��. .. . 8..7.... ` <br /> ..>9P <br /> PHDNE PHONE-. <br /> ........................... .......................... ......... <br /> PLUMBER . . ..................................................................................... <br /> ..... . . . ............................................................................... WELL DRILLER <br /> ADDRESS . ............................................................... i . — <br /> ADDRESS <br /> Y. <br /> PHDNE / � �. p <br /> «��PHGZ0. <br /> < <br /> � a <br /> DESCRIPTIONr <br /> 4. Sanitary Facilities: <br /> 1. Work: 2. New Building Details No. Bathrooms .......... r t7 <br /> New Building .... No. Bedrooms ..........Typeonstruction: <br /> Addition Q Septic Tank Size Gals. .... ..... <br /> Sanitary .......... .... <br /> ......... Size ....�.+..... ft. iY....a�.—. ft. 4a. Absorption Field Site: .......... <br /> Filling/Grading >: <br /> O: <br /> ,,,...,.,. Height............. Stories ............... .� <br /> Moving .......... Area ............... Soil Type ....................... <br /> o i <br /> 17 <br /> Mobile Nome $°Pe .......................................... :b ^ <br /> .......... <br /> Privy ,,,.....,. 3. Use (describe exactly, 1 -family Pere, Rate ................................... � <br /> Well .......... home, garage, motel, etc.) Dry Well .......... is} <br /> Subdivision ,,,,,,,,,, Seepage Trench .......... <br /> .................................................... D. <br /> Camping Unit .......... Privy .......... 1 <br /> .................................................... Seepage Bed \ <br /> — — <br /> — --- ---------- -- — <br /> — ----- -- -- ---------------- --------- <br /> w •-!'C r <br /> Location of 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- so. vi <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. i0 <br /> ____— ____—_— ________________________-___ <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... sq.ft. ............................................................................... <br /> P <br /> N <br /> n <br /> N o <br /> �Oa' 0 <br /> /o o <br /> Ire ° _ <br /> y <br /> be na .ym <br /> n Aaa,or <' _ � c m <br /> m <br /> Z 0 0 D o T <br /> o na 3] <br /> in 0 a <br /> t � m <br /> ....................... .5 .. 7-�s s C <br /> Sign at re o 0 r or Agent Date <br /> X <br /> Remarks ......................................................................................................................................................................... � Q <br /> m <br /> n <br /> n <br /> ......................................................................................................... ... . ........ :U. : <br /> ............ .. ...... <br /> ................................. <br /> N N O N rn <br /> Inspection Date ....................................... ..rn ....... ............. Cp u, rn o v, o u, rn <br /> Zoning ministrator 8 8 8 8 8 Cn <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 plumhing 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 />