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Burnett County Office of Zoning Administrator W A Z <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT _ 3 D <br /> 0 W <br /> }11 <br /> nY ° <br /> TO THE ZONING ADMINISTRATORS The undersigned hereby makes application for a Permit for the work described and located as '� m <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 <br /> .Kf..I...f ........ ........K.N.oW.I. .S........... ..........4. .^�c.R................................... <br /> ..................... <br /> o� <br /> OWNER (please print) CONTRACTOR or SU RVEVOR or AGENT a <br /> 221 ., <br /> QQ77..00.RR.... ...-... ?. ...........f�.... A/..................... a <br /> ADDRESS ADDRESS :A <br /> ..�r�qp�<.....Grope..,...m...N...�........5.�`..�3�.. ............................................................................................ <br /> A . <br /> RESS ADDRESS i--s.J iC <br /> 1 i I .ro <br /> CC�. �.......�z. <br /> ... ...��...5(r?.,�.......................... ............................................................................................ oo ;1 <br /> PHONE PHONE <br /> �_ <br /> ........... ...g. s............Ka<..r..p_ :R.................. ............................................................................................ �� -1 4 <br /> PLUMBSER WELL DRILLER <br /> iA/Et3 STER........ .......... . . . . . . ............................................................................... g <br /> ADDR SS ADDRESS o <br /> .���5 . h!o —960 g <br /> 0 < <br /> ................I......................... ............................................................................................ a0 :yl <br /> PHONE PHONE C, <br /> r <br /> DESCRIPTION 4. Sanitary Facilities: / ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms o .r <br /> .......... i. <br /> New Building ,,,,,, Type of Construction: No. Bedrooms .., .... <br /> X T _ <br /> Addition <br /> .....wQO b......r.R/�m tr.......... Sey�Fie�erdr6i•te-bels. <br /> Hot-bi..+cf 'ri9Na 20r� :(S <br /> Sanitary x„ Size%...... ft. x .. .... ft. pqt, <br /> Filling/Grading ,,,,,,,,,, Height../,.7r...... Stories .....�.. ... 4a. Absorption Field Site: M.A. J IN <br /> Moving .......... Area ........-.70-r 2...S.y... '1.'.. Soil Type .................................... r i4 <br /> Mobile Home Slope .......................................... <br /> Privy .......... 3. Use (describe exactly, 1 family Perc. Rate ................................... :G h <br /> Well We .......... <br /> Well ,......... home,garage, motel, etc.) Dry �1 <br /> Seepage Trench .......... Rf <br /> -------------------------------------- -- --- -------- -- <br /> -Subtlivislon .......... ....1~, //�Lgf ..... n?.!..�C%........ Privy U'1 <br /> Camping Unit A'9t .... <br /> ________________________________________ Seepage Bed--------------- <br /> _—_— � <br /> Location of proposed structures and existing structures,well, sewage systems, roads, eta, 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- <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. ,g i <br /> ----------------- --------------------------- --------------------- :A <br /> 5. Lot Size: 5eH &jkacxD �g� Fig. A. 6. Location: C8 :' m <br /> ................ ft. x .......... .. ft. — tiOfo.). ............... sq. ft. .............................................................................., [ •tl 1 <br /> T5rru<t7ur-t. T Pr0F°Sr� b X60 <br /> •'t2r S i RucTr•r� � � LA tU <br /> l ?� <br /> ° <br /> a ; <br /> E+c+orfa 9 <br /> 7 N r M ? m Z <br /> W C 11. t n Q < m _ E' F <br /> �1o�Jiay y tX1S7'INZ o o' ta a 7 <br /> Vini <br /> .. - ............ ..... , <br /> /........... 5....... . 7. <br /> SignaturOwner or Agent Date <br /> X <br /> Remarks m <br /> va <br /> ........................................................................................................................................................................................ — . . . <br /> n <br /> ....................................................................................................... .. ...................... .. . .................. ................ <br /> +—: <br /> U U N N <br /> Inspection Date ....................................... ........,. 8 0 0 0 <br /> Zoning Administ or 8 <br /> NOTE: A preliminary site inspection must be made an site approval granted on all structures involving sanitary facilities <br /> ,afore construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attacher) to <br /> :s application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build <br /> - <br /> I,. mtil a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> with :s found to exist. Changes in plans or specifications shall not he made without approval of the Zoning Administratoi. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />