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Burnett County Office of Zoning Administrator a o 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 /> 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 <br /> ..,. .. ..r..T...... 'l.A.zy....N...................... ...........5. /... ............................................................... N - o <br /> OWNER (please pn CONTRACTOR or SU RVEVOR or AGENT a tX m <br /> 4.?..T.�T+..�....... .:... ... ....X........................... .ADDRESS............................................................................ESS <br /> ; r <br /> G 437.................................................. ............................................................................................ <br /> ADJy�IE ADDRESS 1 <br /> PH(SfO(NE............................... .......................................... . .................... <br /> ............................................................,......... <br /> PHONE <br /> ........................................................................................... 'W"'E..........R.I.. .LLE.. R........................................................................ <br /> PLUMBER WLL D <br /> ........................................................................................... ............................................................................................ <br /> p <br /> ADDRESS ADDRESS <br /> 0 0 <br /> ........................................................................................... ............................................................................................ <br /> PHONE PHONE Z H <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: No. Bathrooms i <br /> 2. New Building Details ' o <br /> New Building ......,,,, Type of Construction: No. Bedrooms .......... i <br /> Addition T Septic Tank Size Gals. <br /> Sanitary .......... Size ..K4>..... ft. x ..1.�c... ft. .......... <br /> Filling/Grading Height............. Stories ............... 4a. Absorption Field Site: <br /> Area Soil Type .................................... <br /> r <br /> Moving ...... ... ........................................... <br /> Mobile Home Slope =' <br /> .......... .......................................... W <br /> Privy .......... 3. Use (describe exactly, 1 -family Pere. Rate ................................... <br /> Well ....,..... home,garage, motel, etc.) Dry Well .......... r <br /> Subdivision t� /��y1/ Seepage Trench <br /> ...... . .......................... <br /> Camping Unit ,,,,,,,,,, l-Ccl� Privy .......... V` <br /> .................................................... Seepage Bed <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 property is located at a highway inter- o, _a <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING <br /> N: H <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. p' <br /> ______________________________________________________________________ <br /> 5. Lot Size: / S(J Fig. A. 6. Location: <br /> ...�.6.... .. ft. x 41........... ft. — ............................... sq.ft. .............................................................................. <br /> , <br /> N o <br /> O � <br /> �!G V <br /> 5kti Rao <br /> $c-roar�p n/ r O <br /> Add <br /> Zg <br /> 5a —a ?O <br /> z � <br /> 0 <br /> d <br /> r ' <br /> � too <br /> (n 9 d to Z <br /> cr <br /> is <br /> N n W <br /> aam <br /> Z <br /> o _ n ' <br /> \v>Co <br /> Co <br /> Q m <br /> .............. ...................................... o c <br /> Signature of er or Agent Date X <br /> 'n <br /> Remarks ......................................................................................................................................................................... m mO <br /> <» ' <br /> n <br /> Inspection Date ....................................... �/,��^ Mn <br /> .. . ........... . ................... oUouto lin <br /> fpoVff, m <br /> Zoning ministrator i ` o g o 0 o y <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 riot 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 />