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Burnett County Office of Zoning Administrator i? c <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and ° i W <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the ' <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulationsof the Stateof Wisconsin. C. <br /> Vi DL-4 LA K6 Lq 4j7... D:........................ B <br /> ..................... .... ...... . ....................................................... £ <br /> OWNER (Dlease print) CONTRACTOR or SURVEYOR or AGENT e <br /> liQ ..�.... .�t':..G�............................................ 'APPA......�Q..�t........... � 'FVy...��.................... d ;r <br /> ADDRESS ADDRESS <br /> ......... ................................................................................. . . . . ...S........ <br /> ................. <br /> .............. <br /> .................. <br /> ...................... <br /> ADDRESS ADDRES <br /> PHONE PHONE ? :` <br /> .......................................................................... 'W'*.E....L DR..K'L-E'............................. ........................................ : 1 <br /> PLUMBER WLILLER <br /> ..... . . . ............................................................................... . . .... . . ............................................................................ .v . <br /> ADDRESS ADD.. RESS.. m .V7 <br /> n O <br /> ........................................................................................... ................................................... ....................................... ? ». <br /> PHONE PHONE Z « i<.7 <br /> DESCRIPTION 4. SanitaryFacilities: ° o <br /> ro <br /> 1. Work: 2. New Building Details No. Bathrooms .yA. c <br /> New BuildingNo. Bedrooms <br /> ...X... Type of Construction: A <br /> Addition E......... Septic Tank Size Gals. A..... <br /> Sanitary .......... Size ..../P.... ft. x ....�A.... ft. ...... ... i e <br /> Filling/Grading Height....9�.... Stories ...I.......... 4a. Absorption Field Site: <br /> Moving .......... Area .....✓,�.R....fR..F..rr.......... Soil Type .................................... <br /> o <br /> Mobile Home .......... Slope .......................................... ^ <br /> Privy .....,,,,, 3. Use (describe exactly,'1 -family Perc. Rate ................................... <br /> m <br /> Well Dry Well <br /> ,......... home,garage, motel, etc.) """"" m <br /> Seepage Trench z <br /> Subdivision .......... ....«(.V.T .......Lf;.Ul pn...... .......... O <br /> Camping UnitPrivy i <br /> .......... .....15rCuk! lR E...................... .......... <br /> Seepage Bed .......... ? aZ <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is located at 9� ' <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersection. b <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. :�1 o <br /> --- ----- Q E ] :L <br /> 5. Lot Size: Fig. A. 6. Location: :W i <br /> r of SEC—S7 T38.v-RrSW <br /> ................ ft. x .............. ft. — ............................... sq.ft. .fy ,/.Y..........!Y. ...1?t............r.....)........................... :po <br /> O <br /> T3 0 <br /> tj <br /> N O <br /> j�--+.5 j I V i <br /> I o: 's <br /> �V <br /> I o <br /> SrH �o f <br /> D � <br /> mmvmr > mm -0 <br /> 0 H Q < > >n = c m <br /> m No. < — nm ¢ n11 <br /> v p< mc: <br /> O <br /> ZBN `< (Gm <br /> V771, O Via D0i Sn <br /> —1 <br /> C <br /> a ' <br /> o <br /> = 0 0 <br /> Cao +a.......` . ..•....... -.......6.-/p-S? x i r, : m <br /> Signature of Owner or Agent Date <br /> n <br /> Remarks ......................................................................................................................................................................... <br /> m •• <br /> 0 <br /> o : go . <br /> f N n <br /> Inspection Date .................0..................... .. . . . C . . ................ N c°1i, o vt m <br /> . m <br /> Zoning Admini tr for S 8 S 8 y <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities before construc ion <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this application 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 specifications 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 />