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Burnett County Office of Zoning Administrator N o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT o 3 S <br /> ° J <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application fora � '" o <br /> Permit for the work described and located as shown herein. The undersigned agrees that all H <br /> work shall be done in accordance with the requirernrnts of the County Zoning Ordinance, F <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- <br /> lations of the State of Wisconsin. - a fa <br /> 3 <br /> Owner or Agent (please print) Contractor or Surveyor N `, <br /> A-71, f. Gransbu��. Sr. a <br /> Address Address l <br /> m � i <br /> -.S. .365K. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> Phone / Phoneme. <br /> . . . . . . . . . — <br /> Plumber Well Driller <br /> Sir. .. . (�ts�:5. ,. . . . . . . . . i rt <br /> en <br /> Address Address n o <br /> 4O <br /> . .o - #. .7. `f. . . . . . . . . . . . . 'Phoneo <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> r <br /> n O <br /> �^ o <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities v <br /> Type of Construction No. Bathrooms Z o <br /> 1. Work . . . . Dishwasher . . . . . . ° ° m <br /> New Building Size . . . . . ft. x . . . . . . ft. Garbage Grinder . . . . <br /> Addition . . . . . . Height . . . . . Stories . . . . . . Autom. Laundry <br /> Sanitary . . . . . . Area . . . . . . . . . . . . . . . . . . . No. Bedrooms . . i�y� i(17 : r <br /> Alterations . . . . . . Waste Disposal System . . . . . . i V7 i� ° <br /> Moving . . . . . . 5. Permits Required Septic Tank Size Gals. . . . . . . iO <br /> Wrecking . . . . . . Subdivision Absorption Fiel Site 1� <br /> Mobile Home Sanitary Soil Type . . ©�d.i.�. ,� NA <br /> Privy . . . . . . Building . . Slope . . <br /> Well . . . . . . Well . . . . . . Perc. Rate <br /> Subdivision . . . . . . Other (Specify) . . . . . . Dry Well <br /> Conditional . . . . . . Seepage Trench qr N N <br /> 2. Classification Land . . . . Pri �� :0 <br /> vy V :0 � <br /> Zoning Dist. . . . . . . Seepage Bed �r� t6. e ri a o' <br /> 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 /> ____ _____9________ 9_Y <br /> Location of proposed structures and <br /> �� f <br /> existing structures, well, sewage s s- o <br /> tems, roads, etc., should be sketched :Q `Ji <br /> in Fig. A. Include road setback, side <br /> wet( `) s <br /> 75/ and back yard dimension and location <br /> Ile— Ile <br /> Near! and setback from all bodies of water. <br /> If property is located at a highway in- <br /> tersection, show the intersecting high- 'V <br /> ways and the setbacks required along <br /> them and at the intersection. <br /> `lv/vt � 'lifOp�U eone"ic PERMIT FEES <br /> // 44-11w4.kr WSy,,,;�011 $15.0n0 <br /> dl� � and <br /> Use . . . <br /> f1 K Building . . . . . . . <br /> P� <br /> ffC=rwak k o_ Sanitary . . . . . . . fY, <br /> � /+ _(+ Well . . . . . . . . . . . <br /> Y�S�AIh V'�/�T Septic Tank <br /> f7(/ Combination Building, Sanitary <br /> (` and Well 15.00 <br /> Signature of Owner or Agent Date �.., Zonin Adm nistrator <br /> Inspection /.1.. ............ Inspector _/ f. "ri. G7... :fGP..!L.G.4(?..................................... <br /> Remarks ...e.7)&J"< —CS..'Zi`.t':G.`.c..................................................................._....._............................. <br /> ................................................................................................................................................................................................ <br /> ................................................................................................................................................................................................ <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 />