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Burgett County Office of Zoning Administrator <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT g. 3• <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described ind M <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the O <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws nd 3 <br /> regulations of the State of Wisconsin. = - <br /> ....a iIQe...��.]B�Xi.................. bt.uc ..Handriclrs............................................. ..... A o <br /> ER (plow print) CONTRACTOR or SURVEYOR or AGENT '. <br /> 444E;.... .,... ..� ...................................................................................... ..... <br /> ADDRESS ADDRESS <br /> ....Qr7 t alux.Il.....W1.................................................... .....L.ucic, 341.............................................................. ..... ?� <br /> ADDRESS ADDRESS y <br /> fu <br /> ........................................................................................... ...... N. E'......................................................................... rD <br /> . ...... 6a <br /> PHONE PHONE �-- <br /> self <br /> D.onald...Daniels....................................................... ............................................................................I........ ...... : t <br /> PLUMBER WELL DRILLER <br /> Aox...W.......3i.rexi -W2.....54872............................... ..................................................................................... ...... <br /> iDQ i <br /> ADDRESS ADDRESS G <br /> PHOf�_34 -5.533............................................................ .PHONE......................................................................... ...... Z N <br /> ° <br /> DESCRIPTION 4. Sanitary Facilities: P o » <br /> th <br /> Barooms <br /> 1. Work: 2. New Building Details No. <br /> New Building •...X.... Type of Construction: No. Bedrooms ... ...... <br /> Septic Tank Size Gals. 10 O"' <br /> �`& ............ J . <br /> Sanitary ...X.... Size .............. ft. x .............. ft. <br /> Filling/Grading .......... Height............. Stories ..1........... 4a. Absorption Field Site: <br /> Moving 10 6 Soil Type ............................. ...... r E <br /> .......... Area ........�................. ............... o <br /> Mobile Home Slope .............................55.°a'o. ...... � c <br /> .......... <br /> Privy Perc. Rate ........................3. <br /> 3. Use (describe exactly, 1 -family m <br /> Well .......... home,garage, motel,etc.) Dry Well .... <br /> Seepage Trench o <br /> Subdivision .......... .Sing).e..ktcaroe......................... Privy � n <br /> Camping Unit ...... ti <br /> Seepage Bed X. ..- <br /> ---------------------------------------------------_________ _ __ C� <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fi . A. �.., <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is local d at <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersect on. <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> ___________________________________________________ __________—_ _ <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ...1.03....13 ft. x ..235...9.5ft. — .27..,.a.0................ sq. ft. .......Ut.tle...W.Q.Q L,eke........................... ....... _ <br /> O ✓ � <br /> N -O <br /> O J <br /> 4'J <br /> aa <br /> y 30 <br /> 1' 0 <br /> � N <br /> v <br /> I m l:U <br /> Z <br /> 75 ' rt „ <br /> 1�' apse <br /> ed <br /> o <br /> d <br /> 3 Sarm � � N <br /> 1 F6Me E <br /> -_ � <br /> 30t 33 <br /> o) CD u� r DC C -0 Nam '-' nm nag <br /> ST'."" Opt : •G N rn <br /> Onto <br /> Z O '2 D 1 <br /> (nn : S <br /> 2 ^ : m <br /> a c 0 <br /> 9 <br /> e'...........'`3....C`-'`......... ...a. �a......Fs......... . o <br /> Signature of Owner or Agent Date $ <br /> N <br /> Remarks m n <br /> N <br /> ............................. ..... .................. .. ..................................... .....(Tt $ : $ <br /> y. <br /> m <br /> Inspection Date ....................................... .... .. .............. ... ..... $ noonm <br /> Zoning Ad nistrator <br /> $ $ $ $ fn <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary fa Pities before construction <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 beei 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 />