Laserfiche WebLink
Burnett County Office of Zoning Administrator � � o -1 Z <br /> n m y p O <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT _ <br /> _ _ Vv <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application fora � "" o y1 <br /> Permit for the work described and located as shown herein. The undersigned agrees that all <br /> work shall be done in accordance with the requirements of the County Zoning Ordinance, <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- <br /> lations of the State of Wisconsin. �1�1 �� = a � <br /> 3 <br /> d <br /> Owner or Agent (please print) Contractor oe Surveyor <br /> tf y � <br /> C +<.....r. �J. ". . . . . . . J <br /> Address /7 /l//) <br /> Phone Phone <br /> . . . . . .Drill. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i i <br /> Plumber Well er - <br /> p :/ J <br /> Address Address m G7 <br /> n o <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A _ . <br /> o ' <br /> Phone Phone <br /> m p 0 <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: <br /> Type of Construction., FNo. Bathrooms . . . . . . o Z ;� _ <br /> 1. Work v'tt:'o'.5f...A. :..g�.,- ! L...0 No. Bedrooms . . . . . . o <br /> New Building Size . .0 G>, ft. x � . . ft. Septic Tank Size Gals. . . . . . . -, ,� <br /> \\.,, <br /> Addition . .X . . Height . . . . . Stories . . �. . . (JZ <br /> Sanitary . . . . . . Area . . . A !^�:. . . . . . . . . . . 7a.Absorption Field Site: - <br /> Filling . . . . . . Soil Type . . . . . . . . . . . . . . . . . l „ ° <br /> Moving . . . . . . 5. Permits Required Slope . . . . . . . . . . . . . . . . . . . . <br /> Grading . . . . . . Subdivision Perc. Rate . . . . . . . . . . . . . . . . . <br /> Mobile Home Sanitary , , , . . , Dry Well . . . . . . 0 <br /> Privy . . . . . . Building . . . . . . Seepage Trench . . . . . . `0 n i0 i <br /> Well . . . . . . Well . . . . . . Privy <br /> Subdivision . . . . . . Other (Specify) . . . . . . Seepage Bed . . . . . . <br /> Conditional . . . . . . rJ0 '�`� Co <br /> 2. Classification Land Use . . . . . . <br /> Zoning Dist. i� o <br /> 6. Use (describe exactly, 1 - fam. a C ' <br /> 3. Lot Size home, mot1,etc. FOR COMMERCIAL USE ° <br /> . . . . . . . . ft. x . . . . . ft. �� n�O�`� Plans Submitted . . . . . . <br /> . . . . . . . . . . . . . . . . . . sq. ft. 1�z�tit_� Plans Approved <br /> :f <br /> ------------------------ ------------------- --------- ----- ----------- <br /> Fig A. Location of proposed stru tures and <br /> existing structures, well, s wage sys- : <`o <br /> n <br /> (OY' ferns, roads, etc., should b sketched <br /> A l�oS�r Ta �� in Fig. A. Include road se back, side s <br /> / C i' u_j_ _ and back yard dimension a d location <br /> fKx:. J 'o <br /> � �ti16 -1^^( ./r T��C- and setback from all bodie of water. <br /> If property is located ata ighway in- <br /> s tersection, show the inters cting high- <br /> ways and the setbacks reqL ired along <br /> n <br /> them and at the intersectioi. <br /> ` ) PERMIT FEE <br /> Subdivision..... $25.00 + per lot. n <br /> Land Use.�...1.'.. .................. ..... $ <br /> Building.l3GGfb.:�.............. ..... -1A.90 '�/ <br /> Sanitary .......................... .. 26-6 :C� <br /> h.v� Well .................................. ..... <br /> a tT' Septic Tank <br /> Privy <br /> l011�$ <br /> 4 <br /> S nature of Owner or Agent Date Zoning A mist rator <br /> InspectionDate .............................................I....`. Inspector ............. ..(.................................../..... ........................................ <br /> Remarks ...... <br /> ........ +'-... ....�......o-.. <br /> ....... ........... ........................................ <br /> ....................................................................................................................................................... .............I.......................... <br /> ....................................................................................................................................................... ........................................ <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures nvolving 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 p umbing or start any build- <br /> ing until a permit has been issued. A permit may be revoked if misrepresentation of any of the ir formation 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 />