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Burnett County Office of Zoning Administrator o a <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT ; 3, <br /> o i x• <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as '� N <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 CC000de, and with <br /> all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 <br /> ......rill /.. 'C-S;.\.:.................................. ............................................................................................ N io <br /> 0 ER (please' int) CONTRACTOR or SURVEYOR or AGENT o. <br /> .v..... .a..X.....�. . ................................... .............................................................................. `� ` <br /> .y <br /> ADDRESS • ADDRESS <br /> —/— :r, <br /> LA <br /> ................................. .. . . . <br /> V : <br /> ADDRESS ADDRESS A� <br /> ........................................................................................... ............................................................................................ :r <br /> PHONE PHONE M <br /> ........ .............................................................................. <br /> PLUMBER WELL DRILLER <br /> ............................................................................ . ......................................................................................... <br /> ADDRESS AD.. DRESS <br /> ti O <br /> _. < <br /> ........................................................................................... ...............................................................6............................ O <br /> PHONE PHONE Z <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> No. Bathrooms <br /> 1. Work: 2. New Building Details ""Z�� o <br /> New BuildingType onstruction: No. Bedrooms .......... <br /> Addition 9{�.^P r' Septic Tank Size Gals. .......... � •� <br /> ... .. .. .......... ....t'. x......................... .74,T..0`^ <br /> Sanitary .. .. Sizeize ....�s�-... ft. x .�R.d., ft. <br /> Filling/Grading ........ Height........... Stories ............... 4a. Absorption Field Site: i <br /> Moving Soil Type .........4.......................... r- <br /> .......... Area ........................................... . <br /> . <br /> . <br /> . <br /> . 6 o i <br /> Mobile Home Slope . ..................... ............... 3 <br /> ...�.�.... 3 <br /> Privy .. .. .... 3. Use (describe exact) 1 -family Perc. Rate ................................... y ' <br /> Well .... home,garage, motel, etc. Dry Well .......... n A <br /> Subdivision Seepage Trench .......... # ;A <br /> Camping Unit .......... .................................................... Privy • .... .. .. :� ' <br /> Seepage Bed I L .......... r^ <br /> 01 <br /> Location of proposed structures and existing structures,well, sewage systems, roads,etc., should be sketched in Fig A. Include road O .0 :rnt <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 p <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> 5. Lot Size: Fig. A. 6. Location: H N n: <br /> ................ ft. x .............. ft. . ............................... sq.ft. ............................................................................... o :c . <br /> i Ew <br /> N <br /> O O <br /> lJ �1 � <br /> N ^� <br /> O <br /> A <br /> :0 J <br /> }Y m <br /> :W <br /> Z <br /> Z <br /> y Z <br /> N Fp pQ. d�� F <br /> m <br /> m <br /> Z oo' n 7g <br /> o am 3 <br /> � <br /> Se of n <br /> i�.� [ m <br /> ........... ....................er or Agent.............................. ...................................... .:\o <br /> ignaturDate <br /> Remarks ......................................................................................................................................................................... m.� � <br /> m <br /> fn ' <br /> ........................................................................................................................................................................................ M^ II <br /> J <br /> l L / L�iiu !G' ................ 91P o �i'ioam <br /> Inspection Date ....................................... /T Cx2rk�t........:.............. m <br /> ....... ............... . <br /> Zoning Administrator rcj 8 8 8 8 8 8 n <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary 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 />