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Burnett County Office of Zoning Administrator Cie 0 0 <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 located as 0• <br /> < m :\ <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m c <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a G\ <br /> f <br /> ° <br /> N <br /> Q.✓1�.. ..a. .! ......./ i?- Q.<.?51�c......... ............................................................................................ <br /> r.. <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a �" <br /> L1.3..1..©.... a2.�. c� ..... ? ............ ............................................................................................ a <br /> ADDRE S ADDRESS ' <br /> e... ...... i .e........ ..��. ...... I r� <br /> ADDRESS S`•z[j/ ADDRESS <br /> ........................................................................................... . . . . ................................................................................... `7 <br /> PHONE PHONE � : st. <br /> PLUMBER............................................................................ .WELL DRILLER............................................................,...... <br /> ........................................................................................... .ADDRESS........................................................................................... '� . <br /> ADDRESS �l <br /> n o E <br /> PHONE PHONE Z <br /> r <br /> DESCRIPTION 4. Sanitary Facilities: �° o ° _ <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details ••• •� 3i� o w '• <br /> New Building ,,,,,...,. Type of Construction: No. Bedrooms .......... "6:°V 0 : <br /> Septic Tank Size Gals. .......... t <br /> Addition ..... .................................................... 7 V W -� <br /> Sanitary Size ft. x ft. •"'�" ?it <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area ........................................... Soil Type .................................... 'r <br /> Mobile o <br /> Home .......... Slope .......................................... :r+ <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Well .......... home,garage, motel, etc.) Dry Well .......... 14� <br /> Subdivision Seepage Trench <br /> .......... Js <br /> Camping Unit .......... ................................................... Privy W :� <br /> ... .... rp- <br /> .. . ....................................... Seepage Bed I.�Xdy---------------------------------------------------------------------- <br /> a <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched in Fig. A- Include road <br /> C n ;(' <br /> "' <br /> setback, side and back yard dimension and location and setback from all bodies of water- If property Is located at a highway interis C_ <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING [S <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. ' N' <br /> 6 o C: <br /> el <br /> ---------------------------------------------------------------------- `� <br /> 5. Lot Size: Fig. t. 6. Location................................................................. o <br /> ................ ft. x .............. ft. — ............................... sq. ft. . . . <br /> A Woe <br /> _ VIM <br /> IN O <br /> O 7 <br /> 7 <br /> R <br /> r 0 <br /> s <br /> C : t <br /> 01 Z <br /> o <br /> r <br /> e <br /> m <br /> O <br /> U, �( _ _ J 7JNrm rn m Z�mc m c is <br /> n o. E <br /> h � < <br /> o «: m D n m <br /> ' aro <br /> Z o 0 3 <br /> in ra�...... - <br /> � o <br /> � . <br /> .................... a c <br /> . <br /> Signa lure of Ow r or Agent Date .. : : — <br /> Remarks ..1-.�... . /"L! CGS L/ ........................................................................................................................ -n : O <br /> .. ...... ................... �o <br /> o . <br /> o ' <br /> ............... <br /> .......................... <br /> ................/....;(..`............................................................................................ �t— <br /> ............. .L�L 7y„LLyj .. .,' K[v�.[!". .................................. ............ .................................... .II <br /> ....................... <br /> // .......... mInspection Date .. . <br /> .��.. oNoN <br /> ... . ........................... <br /> 0 0 0 0 <br /> Zoning Administrator 8 0 0 0 0 8 to <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <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 be made without approval of the Zoning Administrator, <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />