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Burnett County Office of Zoning Administrator 0 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 <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use ; ? <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 <br /> . �� � 1 ° O <br /> .u..G..►..�.�.e...ah ...!'Jt!!.�.�Lt.R.....hili .».. ............................................................................................ <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a <br /> .a.of.e....,3...........Sox...a..LR ............................................................................................ � m <br /> ADDRESS ADDRESS <br /> .R.e..d..e.n..►..c...,f....1�✓�.. .......... ' .$.�.�... ............................................................................................ <br /> ADDRESS ADDRESS ''� <br /> a..�.-... 8..7.. ........... ............................ ........ ............................. ..... ............ ..................... .................... �� A <br /> PHONE PHONE <br /> . ........... . .. . ....................................................................... <br /> ........................................................................................... :+ <br /> PLUMBER WELL DRILLER <br /> c .o <br /> .......... <br /> ............................................................................ "A' 'D'DRR' ESS- ES"S' <br /> ADDRESS ADo <br /> o' <br /> ..... <br /> . 'ONE................................................................................... <br /> PHONE PHOZ r <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° EC <br /> h <br /> Batrooms <br /> 1. Work: 2. New Building Details No. """"" 0 0 <br /> New Building ,,,....,.. Type of Construction: No. Bedrooms .......... <br /> Addition .....,.... ,,, Septic Tank Size Gals. .......... iit <br /> Sanitary .......... Size .............. ft. x .............. ft. ...I...... <br /> Height 4a. Absorption Field Site: <br /> FillinglGratling ght............. Stories ............... <br /> Area .......................................... Soil Type .................................... <br /> Moving .......... <br /> .. <br /> . Slope .......................................... <br /> Mobile Home ......... <br /> J <br /> Pert. Rate ................................... <br /> Priv J.1 <br /> y 3. Use (describe exactly, 1 -family <br /> Well home,garage, motel, etc.) Dry Well .......... <br /> Subdivision .................................................... Seepage Trench .......... <br /> .......... 1 <br /> Camping Unit .......... .................................................... Privy .......... ;1 <br /> Seepage ......... <br /> -- <br /> N <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc-, should be sketched in Fig. A. Include road Cr <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_ � <br /> section, show the Intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING r� <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> -------------------------------------------------------------------- t <br /> ?j p. 4• <br /> 5. Lot Size: Fig. A. 6. Location: i <br /> ............... ft. x .............. ft. — ............................... s4.ft. ...... . ................................................................. <br /> µJ <br /> L.\ rZ N <br /> Application for land use Camping Permit <br /> from MAY /I l 985 to A/o ✓ /. IV-i 3 o. <br /> (date ) (date) y <br /> 0 <br /> a � ° <br /> p „ <br /> 0. z <br /> `r €09 <br /> n( .y W 7 <br /> W m � c m <br /> No a < F <br /> N _. � d d cV1 rn <br /> � (Sl < re `f f° m <br /> ZO O n n 31 <br /> PO n m <br /> EA <br /> o <br /> ° .... n ...... ........... iZ <br /> /7 �s.... . o <br /> Signature of Owner or Agent Uate <br /> x m <br /> Remarks „ m <br /> m : <br /> ........................................................................................................................................................................................ :U it <br /> 0) : <br /> ......................................................................................................... g . . . . T <br /> NN - m � Nm <br /> U T O U O T <br /> Inspection Date ....................................... ...... .. i m <br /> Zoning Adm nistrator (c-.1� � � 8 8 S '0 8 8 in <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facllitius <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 ml srepresentation of any of the information conveyed here- <br /> with is found to exist. Changes in plans or specifications shall not he made without approval of the Zoning Administratoi. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />