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moi? ,:D. <br /> Burnett County Office of Zoning Administrator U a <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> m <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as 0. <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m fa) <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 0. <br /> z.; ti. �. �1... .......0 .h...j, f<.. ....................... ......c�....Y..w.. Nd.. <br /> . ........13.,...N..p.J. v.�I........ <br /> OWNER (please print) OO CONTRACTOR or SURVEYOR or AGENT a <br /> .....1��.d.S...LY.n.h.....n.. lf...5�.... .�a..a.. .....a..Q.J.................................... LAJ <br /> ADDRESS / ADDRESS \1 <br /> V <br /> �.r,..........................l vt 5� .�'. ..!......... .....��. h..kL ..K.�Yr... r , <br /> . .................. .. <br /> ADDRESS ADDRESS <br /> ...... ..7..s�:...7..33 .:................................ ... ... . . s:.y..... . . <br /> -Y..................................... <br /> PHONE PHONE <br /> 01 <br /> .......... <br /> ........................................................................................... ..WELL..........DRILLER.. ..... ............................................................... 1 '(� <br /> PLUMBER <br /> p <br /> ADDRESS ADDRESS a <br /> ........................................................................................... . ...................................... <br /> ....... <br /> ......................... <br /> ................. <br /> 'Z N 4 <br /> M <br /> PHONE PH....ONE <br /> DESCRIPTION 4. Sanitary Facilities: ° g o <br /> 1. Work: No. Bathrooms ; ^ <br /> 2. New Building Details """"" LC) o <br /> New Building .......... Type of Con;truction: No. Bedrooms .......... <br /> Addition d Septic Tank Size Gals. .......... •— <br /> ...K.. .....W.A.C'.................................... < <br /> Sanitary .......... Size ...oll..... ft. x ...A.'(.... ft. . ........ <br /> Flllingf Grading .......... Height............. Stories .J............ 4a. Absorption Field Site: <br /> Moving .......... Area .,0.4w.:...... ............ Soil Type .................................... i rp <br /> Mobile Home Slope .......................................... <br /> .......... <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... E <br /> Well .......... home,garage, motel, etc.) Dry Well .......... <br /> Subdivision / ��.sf-hp Seepage Trench .......... <br /> .......... �^ ty. ................. <br /> Camping Unit / Privy .......... : <br /> .......... .................................................... Seepage Bed9� <br /> ......... <br /> Location of proposed structures and existing structures,well,sewage systems, roads,etc., should be sketched in Fig. A. Include road Q <br /> setback, side and back yard dimension and location and setback from all bodies of water. If propertyis located at a highway inter C7 a <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING H <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. n <br /> __ <br /> 5. Lot Size: Fig. A. 6. Location <br /> Uj <br /> ................ ft. x .............. ft. . ............................... sq.ft. .......:....................................................................... (f` <br /> 1Q7 m <br /> ztn <br /> N o <br /> o <br /> � GhPGL Drain <br /> Y T <br /> Z Z <br /> O <br /> m <br /> 7� (nr v � wmz <br /> c m m c m <br /> m N a m.•G - m» p m <br /> b : C <br /> yam <br /> Z o o - - n ]I7 <br /> 7 :�o —4 <br /> w so C <br /> Signat�urejof Own r r Agen 11R/�/Date / X <br /> / . .. <br /> Remarks k.l. ✓Z'.. :a`.............................................................................................................................................. <br /> ._.. T <br /> 4wfA <br /> ........................................................................................................................................................................................ <br /> . . <br /> .............................p.................................................................................................... . .. . ............................:\ <br /> Inspection Date .C.... .. .7 I ..... < f r u• ••••.• • .. m <br /> .............. .... .... . .. m4'. <br /> v, <br /> Zoning Admini atorg y <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary fs <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 plumbing 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 tie made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />