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Burnett County Office of Zoning Administrator o <br /> CD CD y p O <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT -a 3 <br /> n <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a —I — :oil o <br /> Permit for the work described and located as shown herein. The undersigned agrees that all a, us <br /> work shall be done in accordance with the requirements of the County Zoning Ordinance, x cp <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- - °- :' <br /> lations of the State of Wisconsin. 3 a <br /> )0 • o <br /> .kAl.1.I.II A rik -Pt . W A g E P I er L-D S z L F _. ,4 <br /> Owner or Agent (please print) Contractor or Surveyor y <br /> C <br /> 17.7p- LA CV„ssE .>�v8 a <br /> l ... . . --"• <br /> Address PAL L/ /nN /"9 Address a � <br /> / <br /> CD • <br /> Phone Phone l' <br /> 1 <br /> ~ <br /> Plumber Well DrillerIn <br /> N <br /> Address Address Ni -''' G '\ <br /> ° .. <br /> Phone Phone CO o V <br /> CD o r« <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: -° <br /> T e of Construction No. Bathrooms o z °° A......1. Work ./aAt *1 5 No. Bedrooms ° a <br /> New Building Size . .i ft. x .3. . ft. Septic Tank Size Gals. .Z <br /> Addition Height / . . Stories . 0 <br /> Sanitary Area 7a.Absorption Field Site: <br /> Filling Soil Type 0 <br /> Moving 5. Permits Required Slope p <br /> Grading Subdivision Perc. Rate /" <br /> Mobile Home Sanitary Dry Well CO m 1'1\ <br /> Privy Building Seepage Trench CD <br /> CD <br /> Well Well Privy <br /> Subdivision Other (Specify) Seepage Bed o (A <br /> Conditional <br /> 2. Classification Land Use a *, <br /> Zoning Dist. < <br /> ,..,,, o <br /> 6. Use (describe exactly, 1 -fam. H•-, <br /> 3. Lot Sizehome, motel,etc.) FOR COMMERCIAL USE °.C <br /> 0-OO ft. x ?O ft. Plans Submitted N_..� <br /> sq. ft. Plans Approved <br /> Wli <br /> — — U-3 <br /> Fig. A. Location of proposed structures and Q ^�,_i <br /> existing structures, well, sewage sys- —•� : 3 <br /> tems, roads, etc., should be sketched ( ° <br /> in Fig. A. Include road setback, side s <br /> and back yard dimension and location 0 > a <br /> and setback from all bodies of water. C 1,t <br /> If property is located at a highway in- <br /> tersection, <br /> W <br /> show the intersecting highOj IS. <br /> - <br /> ways and the setbacks required along (J C <br /> them and at the intersection. <br /> PERMIT FEES <br /> -'.4 Subdivision $15.00 CD <br /> SAG' Land Use 1.00 D '•`- <br /> Building 5.00 C <br /> Sanitary 10.00 t <br /> Well 5.00 P.. <br /> Septic Tank 10.00 14 <br /> Combination Building, Sanitary <br /> cA g A.6 e in og c 77 N 5 /7 /— xeiK and Well 15.00 <br /> Privy 5.00 <br /> �-! n/ 6" , AAAC6 `.fLr <br /> pay° 4 _ _. � ' <br />