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Burnett County Office of Zoning Administrator C _ z <br /> '•APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 ° g <br /> r' ° <br /> TO TFjE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as H o ;b <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use c <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a �C <br /> Q 0 1. <br /> r:le.5.........W.......5�a-d.. .�"..................... .......................................................................................... N r O <br /> Neil <br /> (please print)L y A CONTRACTOR or SURVEYOR or AGENT m m <br /> P.!f.'.il.....HLi77..S c.,�t...f! k. . 4 � �' <br /> ff�� 11 i <br /> ADDRESS /.s. � .( ��...... ............................................................................................ - <br /> A / ADDRESS <br /> l:l. .. ,5.........�U�fi].rT..............J��.. /1......................... m . <br /> ........................................................................................... <br /> A.DRESS ADDRESS <br /> ..................................................................................... <br /> PHONE PHONE <br /> ................................................................... . .......................................................................................... <br /> PLUMBER WELL DRILLER � <br /> .................................................................................... ....................................................................... 0 <br /> ADDRESS ADDRESS �f <br /> :"Q � G) <br /> h o <br /> PHONEPHON.E........................................ ....................................... `>'° ° <br /> z ti <br /> DESCRIPTION 4. SanitaryFacilities: ° o <br /> 1. Work: No. Bathrooms T <br /> 2. New Building Details <br /> .......... . <br /> New Building No. Bedrooms .. : m <br /> .�..... Type of Construction: <br /> Addition Septic Tank Size Gals. ................................ ....................... .. t <br /> Sanitary . ..... Size ... ..�... ft. x ..3 -.... ft. .......... � <br /> Filling .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area ?..�. . Soil Type .................................... (A :® <br /> r <br /> Grading Slope ......................................... ° <br /> Mobile Home .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... c <br /> Privy •...• home,garage, motel, etc.) Dry Well .......... a <br /> Well X..... .................................................... <br /> Seepage Trench , <br /> Subdivision Privy .......... —� <br /> ............................................. Seepage Bed i <br /> ......... <br /> ------------------------------------------------- --------- N <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc.,should be sketched in Fig. A. Include road t rf1 <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- a <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 /> ----------------------------------------------- Q <br /> 5. Lot Size: l,/ Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — f � a-a 11 e 5 II1� <br /> sq.ft. ............................................................................... <br /> iC- <br /> Cn <br /> CD <br /> ro \ <br /> N h <br /> cn t� <br /> \. 7. <br /> Z C <br /> ° <br /> ID <br /> D <br /> �o tn cnooz <br /> CD c '. m Z) c CID <br /> LD, N Q 0- <br /> v <br /> oy' C ' m <br /> z o <br /> C <br /> Cr <br /> m <br /> ....... . ..................... ............. ................. <br /> ' <br /> 0 C <br /> i nature of Owner or Agent 0 Date f�° � C <br /> CD <br /> �F. X <br /> emar s ... ...!!%.... . ��.....�.................. <br /> ............................. ................. � M. <br /> C <br /> ... ...... . <br /> ............�. .. .9..� � �. .. .................. <br /> ........................................ <br /> nspection Date ... ..:� �.�.��......... ...... ~ o 0 0 o c(n m <br /> ......... 11. <br /> Zoning A�rator :� 00 0 0 (min <br /> OTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> More construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> its application before a permit will be issued. Do not purchase or install a septic tank, do any plumhing or start any build- <br /> g until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> ith is found to exist. Changes in plans or specifications shall not he made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />