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Burnett County Office of Zoning Administr for 6" e <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT m 3. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and 0 <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 :0 <br /> regulations of the State of Wisconsin. <br /> .QW=S!GtS�C?1.r,.r����I, . ]..�...Z....................... ...................................... .L...................................... ...... c A 3 <br /> OWNER tplease print) CONTRACTOR or SURVEYOR or AGENT $ <br /> SS!3.... ' 141 <br /> ..................................................................................... ......... .....t .... .................................. <br /> ADDRESS d s � <br /> ADDRESS <br /> €c,.) <br /> !N1e . �u' T�r� Mn �.��o <br /> hy €� <br /> .................. <br /> ....... .............. ..................................................................................... ...... <br /> ADDRESS <br /> ( 42k.. 7,.. 1�d 451-JIGI.�sY>euy." . . . . . . x -1 <br /> PHONE -• � � � • •• •. .. ... <br /> .... .9. ... t.n..5.............................. ..................................................................................... ...... <br /> PLUMBER WELL DRILLER ° ;r• <br /> ...................................................................... ..................... :t <br /> ADDRESS ADDRESS 0 G <br /> ... <br /> PHONE................................................................................ .PHONE.................................................................... <br /> 4. Sanitary Facilities: . . ...... o "P <br /> DESCRIPTION Z 0 :A <br /> ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms <br /> Now Building .. ..... Type of Construction: No. Bedrooms . ,... aO <br /> Addition ... . .... ;)� ........ .....l.. ;:':,'�........... .. ...... Septic Tank Size Gals. <br /> Sanitary ✓,/ ...... ,.�.' <br /> ..l.�.... Size ....�.'.�.... ft.x ...:. ... .... ft. <br /> Filling/Grading .......... Height............. Stories ...I:.N.a:ICrj 4a. Absorption Field Site: <br /> Moving Soil Type .................................... ...... <br /> .......... Area ........................................... O <br /> Mobile Home Slope .......................... <br /> .......... .�sJ• <br /> ...... '. <br /> Privy .......... 3. Use (describe exactly,'1 -family Perc. Rate ........................... ...... <br /> Well ......•... home,garage,motel, etc.) Dry Well .. ...... T <br /> subdivision Seepage Trench Z <br /> .......... ..................... .. ...... o <br /> . Cha................ ' <br /> i <br /> Camping Unit .......... Privy .. ....... <br /> ............................................... .... Seepage Bed <br /> I <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fi . A. C C <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is local d at <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersect on. :C:> ; <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> I l l{ �-y(..�'.:5:...... q. 'fri K-U IGyV „l.l;t--. <br /> ____________________ <br /> ____________ <br /> 5. Lot Size: 7, Fig. A. 6. Location: — <br /> 2 I ': ....�. ft. x ........::r4. ft. — ........... .' s ft. L....y . ......4�. . ...V1 S:.U..V_L...... '1.�. <br /> >� <br /> fr I . .... I.:-�.L <br /> ilk <br /> 0 O <br /> A, 0 A n <br /> c <br /> a <br /> \ 1. o L <br /> 7 <br /> � b <br /> D Nvmr' D W C C <br /> v m <br /> O m m <br /> W O N <br /> .. : M <br /> c o o <br /> krl n / <br /> �) u �-.4C.. t%' 1;,,�.Z �.4rf, O <br /> � Y . ...... ........ . ........ ........ . ...... p <br /> Signature of OCvner Agent `/ Date o <br /> o . <br /> Remarks <br /> m �• <br /> v <br /> O . S <br /> ....................................................................................................... .......... .................. ............................. .... - O <br /> ........ <br /> �i 1 H T <br /> Inspection Date ....................................... .. . .y!..... .. :.('.�f ..................... ... uNi ooi uNi o o r�i� m <br /> Zoning A, nistrator S S S S S S of <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary fa ilities before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this appli ation 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 been 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 />