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-j t i C: ' <br /> Burnett CdunW Office of Zoning Administrator iu - 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> 0 <br /> l-O THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as ec 7 <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 applicableCountyOrdinances and the laws and regulations of the State of Wisconsin. a <br /> /....r1.i!!... .... ........ .�fI..`i !!n...fll.. * ....................................................................................... a <br /> OWNER (please prin . CONTRACTOR or RVEYOR or AGENT m <br /> ..�f../../..:. A............ 45/�t. :R.......... �..`1...�r�..r........ ........................... .j�.�. ....:��......................................... a 1 <br /> ADDRESS ADDRESS <br /> ADDRESS............................................................................ .ADDRESS............................................................................ <br /> .......N...j....................................../. .... ............................. .PHONE................................................................................ <br /> PH <br /> . L'U..,/.{ ...................................... .............................. ............................................................................................ <br /> PLUrA E WELL DRILLER <br /> �� .......1rr..an..7 . . �r...'.............. ............................................................................................ <br /> ADDRESS ADDRESS <br /> / <br /> PHc1 <br /> gr p�'3t.. Sly... <br /> ............................ . . . . ............................................................................... O .:6 <br /> � <br /> E PHONE ' <br /> DESCRIPTION Z ° <br /> 4. Sanitary Facilities: ° 0 <br /> o ° <br /> 1. Work: 2. New Building Details No. Bathrooms ..�.... o a <br /> New Building .,.....,,. Type of Construction: No. Bedrooms .......... "R <br /> Addition yy $ /_r/Tank Size Gals. ` <br /> Sanitary ...V... Size .............. ft. x .............. ft. /�N ur/1.�7 O?-a11d� :A <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorpti Field Site: <br /> Moving .......... Area . . . .. Soil Type .................................... o <br /> ............................. ... . . ... <br /> Mobile Home Slope .......................................... e <br /> Privy .,,,,,,... 3. Use (describe exactly, 1 -family Perc. Rate ................................... 3 <br /> S f1 <br /> Well .......... home,garage, motel, etc.) Dry Well .......... p ;p <br /> Subdivision Seepage Trench .......... A t� <br /> Camping Unit .......... <br /> .................................................... Privy ...I...... Q <br /> — — Seepage Bed <br /> - ----- <br /> --—___ d :0 :[ <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. Include road { <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- °- <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING <br /> C <br /> STRUCTURES ANDPROPOSED STRUCTURES AND ADDITIONS. <br /> — -- p <br /> — --- ----- -------------9__------ -- <br /> — ------------------ it i jam, <br /> S. Lot Size: <br /> Fig. A. 6. Location: <br /> c <br /> ................ ft. x .............. ft. . ............................... sq.ft. ............................................................................... h <br /> u: <br /> n <br /> N o <br /> O 3 <br /> O \ <br /> O <br /> J <br /> rr\S4.`, <br /> T <br /> N <br /> es <br /> vvC <br /> 9 0 W Z <br /> m a s < 0 �_ n E <br /> N _: W <br /> < <br /> -O Ul ,� ro C <br /> Z oo oar^ <br /> o a ° 3 <br /> in <br /> 0 <br /> /f �y b <br /> 0 <br /> m <br /> Sign wner or Agent Date ' C <br /> f O <br /> X <br /> m <br /> Remarks ......................................................................................................................................................................... � C <br /> e ' <br /> II <br /> .................................................................. .... . .................................�.,........................ .. ...... <br /> Inspection Date ....................................... ......................................� .GZ9icCa /" T.Cb azc. ?L�.sI........................ t c N . N m <br /> Zoning Administrator XC,1 Ti $ 8 $ 8 8 rn <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures Involvinosanitary 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 />