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(Z7r(P' <br /> Burnett County Office of Zoning Administrator �' o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3. ? ) <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and 'Z q ;6^ <br /> ocated as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements oi the m c <br /> lurnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 A <br /> egulations of the State of Wisconsin. y �- • " <br /> ........�...1... i.jt.°v...k:...../..................................... {� ......:-..................... ...... <br /> OWNER Iplaasa Driritl air, CONTRACTORor SURVEYOR or AGENT & rte <br /> ...... lF. �l �i......l. .F..L..`.-. r •...................... ...............`.........r......�:...: t.( itr� ..... �. / <br /> ADDRESS ,���try{yty[; {fjy� r IT"I�V j ADDRESS 1,� <br /> 7l m <br /> .......i.e.�. . .re.. .C. ...... ..'}.:..�............��.`..�......... ........... .................................................................................... ....... i <br /> ADDRESS ADDRESS <br /> .......................................... ....... <br /> ........................................................................................... .....O...NE.................................. <br /> PHONE PH <br /> .. . ...... ............................................................................... .W.EL. ..... <br /> DRILL.R'*I'L ..ER............................................................... ....... \ <br /> PLUMBER L <br /> O - <br /> ADDRESS ADDRESSn o i� <br /> PHONE................................................................................ .PHONE........................................................................ ....... 3 ,�.� <br /> Z r 6 <br /> DESCRIPTION 4. Sanitary Facilities: ° c ° <br /> 1. Work: 2. New Building Details No. Bathrooms c <br /> Nev, BuildingNo. Bedrooms <br /> ..; .... Type of Construction: '• ••""' i R <br /> Addition .......... ........(, ,}. ......... ..... Septic Tank Size Gals. .. ....... <br /> �.4/•• / <br /> Sanitary Size ...A.�.:.., ft. x ....7..L7... ft. .. ....... . <br /> Filling/Grading .,........ Height.....`.?...... Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area Soil Type .................................... o <br /> Mobile Home Slope .................................. ....... v .. <br /> .......... <br /> Privy .......... 3. Use (describe exactly,'1 -family Perc. Rate .......................... ........ m <br /> Well .......... home,garage, motel,etc.) Dry Well ..... <br /> Subdivision <br /> Seepage Trench o <br /> ""' <br /> .......... ........ ..,}....................................... Privy <br /> Camping Unit .......... �,.7 r,..�.. . ........ <br /> ..............4.�.:�.. r✓...................... Seepage Bed <br /> N <br /> Location of proposed structures and existing structures well sewage systems, roads, etc., should be sketched in Fi . A. c <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is loca ed at $� <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersec ion. <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. t r <br /> ________ -------------------------------------- -- <br /> 5. Lot Size: Fig. A. 6. Location: Q <br /> ...... ......... ft. x .............. ft. . ............................... sq.ft. ...................................................................... ........ 1 _ <br /> -- �J a <br /> N O <br /> O <br /> ire �t f <br /> U, <br /> �� ^ - <br /> .en m <br /> a <br /> t <br /> 1 <br /> 1 1 7i <br /> % <br /> i N ( ^� Gl r (Dj m m -0 <br /> `<f �' O. o 6 6 <br /> V o < d c <br /> No ya <br /> Gv <br /> .o..Y7.......... ........... .............................. `.T.. .g.. <br /> ODate or Agent <br /> 8 <br /> N <br /> Remarks m n <br /> N <br /> ................ ...... O <br /> ................................................................................................... ......... ... 0 <br /> O <br /> ... ... ... ... .... .. . . .... .. <br /> cap c <br /> Inspection Date N m N J ro <br /> Zoning Administrator( T� 8 8 88 8 <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary f cilities 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 been 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 AF PROVED. <br />