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Burnett County _Office of Zoning Administrator o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application fora __1 '" o _ <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, x <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- v o- <br /> lations of the State of Wiscons'n. a <br /> �n h� O <br /> Owner or Agent (please print) Contractor or Surveyor <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . a <br /> ddress Address a _ <br /> d <br /> Phone Phone , n <br /> .� ce.� . . . . . K .r . . . . . . . .el. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> . � <br /> Plumber Wl Driller <br /> . . Ute Q.S.T. �. . . .�f SG. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .� � � �� <br /> Address <br /> V n o <br /> OT, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> Phone Phone <br /> 0 <br /> n „ O <br /> o <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities <br /> Type of�C/onstruction No. Bathrooms �. . . z z o <br /> 1. Work 4-!(�l/.5 . . . . . . . . . Dishwasher . . ° o <br /> New Building X. . Size .2.6. ft. x .fid. ft. Garbage Grinder -- <br /> Addition Height /- tones .l,.v. Autom. Laundry , . <br /> Sanitary . . .�, . Area . .ZV.. Q No. Bedrooms <br /> Alterations . . . . . . Waste Disposal System <br /> . . . <br /> Moving . . . . . . 5. Permits Required Septic Tank Size Gals. 4/ <br /> Q�r� <br /> Wrecking . . . . . . SubdivisionAbsorption Field Site <br /> Mobile Home . . . . . . Sanitary . .( Soil Type 2CCL:a'Y-5A-j'A - - <br /> Priv . . Building <br /> ` �-� (� <br /> Privy g k. . . Slope u�7 Ctv. . . <br /> fA <br /> Well K Well k. . Perc. Rate <br /> Subdivision . . . . . . Other (Specify) . . . . . . Dry Well . . , . . . o = <br /> Conditional . . . . . . Seepage Trench O N N <br /> 2. Classification Land . . . . . . Privy a' <br /> Zoning Dist. Seepage Bed . . ;Q a o <br /> 6. Use (describe exact(1 _:fa <br /> i <br /> 3. Lot Size home, motel,etc.) FOR COMMERCIAL USE <br /> ftx ft. dM h p/y/4-- Plans Submitted . <br /> T.L�. . sq. ft. / Plans Approved . . . . . . <br /> -----c-----r—�--------------------- — <br /> _r�m+1U PICAID Fig. A. N Location of proposed structures and <br /> existing structures, well, sewage sys- f <br /> tems, roads, etc., should be sketched <br /> in Fig. A. Include road setback, side <br /> and back yard dimension and location <br /> i and setback from all bodies of water. q <br /> If property is located at a highway in- VJ <br /> tersection, show the intersecting high- "N� <br /> Of ways and the setbacks required along <br /> them and at the intersection. <br /> PERMIT FEES � <br /> Subdivision . . . . . . . . . $15.00 <br /> b Land Use . . . . . . . . . . . 1.00 ?� <br /> p Building . . . . . . . . . 5.00 <br /> Y E Sanitary . . . . . . . . . . . 10.00 <br /> r 1 Well . . . g <br /> y jo Septic Tank 1°0 ' <br /> Combination Building, Sanitary <br /> fand Well 15.00 <br /> . <br /> ...................... .. '.-...x.6..-.7..7........ ... ........ .............. <br /> Si nature of Owner or Agent Date o in dministrator <br /> 9 9 9 <br /> InspectionDate ................................................ Inspector ................................................................................................ <br /> Remarks ............................................................................................................................................................ <br /> ................................................................................................................................................................................................ <br /> .............................................................................O..K......................................................................................................... <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 />