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Burnett County Office of Zoning Administrator A oelq 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and locIted as '� m •* <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Laid Use 1 c p <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> ... F M. .... e C f <br /> r I/ ....... ..o..o..z........................... <br /> OWNER idle a printf�)---- CONTRACTOR or SURVEYOR or AGENT m m <br /> ..&...l.. C.L <br /> 1..'r.............................. .......................... ................ ..... ...................................................1 .. <br /> ADDRESS ADDRESSF <br /> .. Q <br /> ADDRESS............................................................................ .ADDRESS..................................................................�i........ <br /> t! <br /> .. ................................................ y t <br /> PLUMBER /fit— WELL DRILLER ' <br /> PHOyi@..... ! ,I. ....................................... PHONE 1 h9 i <br /> ....... �. '.. ....... ...........................................................I <br /> ........................................................................................... ......... <br /> . . . . . . ............................................................................ <br /> ADDRESS ADDRESS o <br /> c <br /> ........................................................................................... .PHONE........................................................................................... : 0 •" Q <br /> PHONE <br /> DESCRIPTIONr <br /> 4. Sanitary Facilities: P <br /> 0 P 0 :di <br /> 1. Work: 2. New Building Details No. Bathrooms ......... V c <br /> New Building Type of Constr tion: "" $ '� <br /> Addition <br /> Size .............. x .......... ft. Se ' Bedrooms <br /> Addition , , �•S•„�,y„ <br /> Septic Tank Size Gals. ......ti o <br /> ...... <br /> Sanitary C. .... 3 <br /> • 4a. Absorption Filling/Grading ,,,,,,,,,, Height............. Stories ............. . ptionFieldSite: -tti� c <br /> Mobile Home ...... ... Slope .............. .... .............I......... f i to i <br /> Soil Type .............. <br /> .......... <br /> Priv 3. Use (describe exact) 1 -family t o <br /> Moving Area ��•��•������ <br /> Y Y, Y Perc. Rate ........�. ...... .. <br /> Well .......... home,garage, motel, etc.) Dry Well --CJUar ;.{0..... tk ? <br /> Seep <br /> Subdivision ......•...Unit ......•... <br /> Privy <br /> { � <br /> . .................................................. <br /> Camping o <br /> ...................................... . <br /> Priv <br /> Seepage Bed t i <br /> -------------------------------- ---------------------- -- W <br /> Location of proposed structures and existing structures,well,sewage systems, roads,etc., should be sketched in Fig. A. Include road tv <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter W a I I' <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING i- H <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> 0 <br /> Nt5. Lot Size: Fig. A. 6. Location--------------------- e ' <br /> ................ ft. x .............. ft. — .............................. sq.ft. ...... ......... ........ u Rl <br /> 0 <br /> N p <br /> O 7 <br /> [tA� <br /> v f <br /> _In k <br /> :Q� <br /> Z <br /> O <br /> A <br /> d <br /> (r1/J11'/ m <br /> =7 N r vm Z <br /> NJ <br /> mzC m <br /> Z o o' D a 31 <br /> o p nn <br /> \� omoa <br /> pw o 1 <br /> ��........ ...... . 441, <br /> .9.......�....... ............... ...7.. .1.�'AA....... w <br /> Si natu of Owner r A ant <br /> Date <br /> `�° C <br /> Remarks ........................................................................................................................................................... v <br /> .............. <br /> T : <br /> M <br /> ............................................................ <br /> ................................................................. <br /> n <br /> Inspe4on Date ....................................... �, '..� .I�: N U o o r$ m <br /> ........ ..... . <br /> G7�!zt�2. . .......... ................... .... . m <br /> Zoning Administr or (O� : : 8 8 8 8 8 8 0 <br /> NOTEhifliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> before CO in. In the case of sewerage disposal systems, a <br /> this apPlicafiction can begin. 9 P Y Copy of the percolation test must be attached to <br /> ing until a p6efore a permit will he issued. Do not purchase or install a septic tank, do any plumbing or start any build <br /> - <br /> Wlth is found 'has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> SEWER SYst. Changes in plans or specifications shall not be made without approval of the Zoning Administrator. <br /> SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />