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Burnett County Office of Zoning Administrator N o H z <br /> (D CD N 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT °. 3CD <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a -I ' o k.\I <br /> Permit for the work described and located as shown herein. The undersigned agrees that all co N <br /> work shall be done in accordance with the requirements of the County Zoning Ordinance, � t <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- v a <br /> latio s of the State of Wisconsin. p <br /> Z.._. *D <br /> CD <br /> Owner or Agent plea e print) Contractor or Surveyor H • ,..-CS <br /> 1 (' i i"-' 40 a Ile 22C S..;/- R1J-1/-2141 /I .7^' 74/' 63 (€ I/;14 ' 2- i <br /> Ad ....t <br /> dress Address a <br /> 9 CD <br /> Phone Phone N <br /> N.. r <br /> J <br /> Plumber Well Driller .44 <br /> 0Z.. <br /> Address Address tom, o <br /> '+ < <br /> Phone Phone o 7 <br /> r <br /> 0 <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: -o <br /> Type of Construction No. Bathrooms C.," z z ° <br /> o 73 <br /> 1. Work No. Bedrooms U‘;'l 1 <br /> New4u.i.)ding Size ft. x ft. Septic Tank Size Gals. ^! .< <br /> Addition_ ' . Height Stories I <br /> V <br /> Sanitary Area 7a.Absorption Field Site: N. <br /> Filling Soil Type . o o <br /> Moving 5. Permits RequiredSlope <br /> Grading Subdivision Perc. Rate <br /> Mobile Home Sanitary Dry Well m CD <br /> Privy Building Seepage Trench CD <br /> CD <br /> Well Well Privy o 0 <br /> Subdivision Other (Specify) Seepage Bed o <br /> Conditional c' \$ cn cn <br /> c Co <br /> 2. Classification Land Use ''L. <br /> 0 <br /> Zoning Dist. PR-2 • ° <br /> pg 6. Use (describe exactly, 1 -fam. — ° <br /> 3. Lot Size home, motel, etc.) FOR COMMERCIAL USE \ ° <br /> ft. x ft. Plans Submitted <br /> sq. ft. Plans Approved <br /> tld V.ig.4. Location of proposed structures and —I <br /> existing structures, well, sewage sys- 0 <br /> tems, roads, etc., should be sketched 3 <br /> t /' ' <br /> in Fig. A. Include road setback, side 7 <br /> /1and back yard dimension and location o <br /> and setback from all bodies of water. <br /> If property is located at a highway in- <br /> tew high- <br /> y// <br /> ��was andrsection,theshosetbathecksinterersequiredcting along <br /> n6fr <br /> .s Ifs theym and at the intersection. <br /> zi <br /> 1 / CFC1 77 PERMIT FEES c <br /> co <br /> ,�.(f�� � Subdivision $25.00 + $2.00 per lot. <br /> �// o'f74'' 4( Land Use $10.00 N. <br /> Building 1.0L: 4s, <br /> �j Sanitary 20.00 <br /> Zh£ � o'I� Well 10.00 <br /> Septic Tank 10.00 <br /> Privy 5.00 <br /> . . ilfr <br /> Signature of Owner or Agent Date Zoning Administrator <br /> Inspection Date Inspector <br /> Remarks <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 he made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />