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-Burnett County Office of Zoning Administrator o --I Z <br /> W 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT " 3 y <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a "" 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, m <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- - ° r <br /> lations of the State of Wisconsin. 3 rQj g O <br /> Larry. Bjork11und. . . . . . . . . . . . . . . . . . . . . . . . self. . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> Owner or Agent (please print) Contractor or Surveyor N t4 <br /> rt. 1 Webster, Wi. 54893 a (b <br /> . . . . . . . . . . . . . . . . . . <br /> :A <br /> Address Address a S <br /> .866-4288•off.• • -8298•lam. . . . . . . . . . . . <br /> Phone Phoney <br /> Hopkins <br /> Pl <br /> umber Well Driller :� p <br /> N, <br /> .Webster. . . . . . . . . . . . . . . . . . . . . . . . . . . . o <br /> Address Address 4t m o <br /> = `. <br /> .866-.4557. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . M 7T <br /> Phone Phone <br /> r- <br /> 0 <br /> R <br /> o <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: <br /> Type of Construction No. Bathrooms • •1• • • o Z 00 <br /> 1. Work . .frame. . . . . . . . . . . . . . . . No. Bedrooms .2• " - � ' <br /> o , <br /> New Building X. . . Size . . 24 ft. x 28 . . . ft. �£ank T,e �3als. <br /> 1 o na jjan 2000'ga1s. <br /> Addition . . . . . . Height Stories . . . . . . �.e . . . . . <br /> Sanitary . . .X. . Area 6?7. e . . . . . . . 7a.Absorption Field Site: <br /> Filling . . . . . . Soil Type . . . . . . . . . . . . . . . . . . 0' <br /> Moving . . . . . . 5. Permits Required Slope <br /> Grading . . . . . . Subdivision Perc. Rate <br /> Mobile Home Dr Well <br /> . . . . . . Sanitary . ,X„ • Y • • • • • • <br /> Privy . . . . . . Building . .X. . . Seepage Trench . . . . . . , <br /> Well . . .?t. . Well ,X• , • Privy <br /> Subdivision . . . . . . Other (Specify) . . . . . . Seepage Bed . . . . . . <br /> Conditional . . . . . . \ OU tiCn <br /> 2. Classification Land Use <br /> Zoning Dist. -2 0- <br /> 0 <br /> K� 6. Use (describe exactly, 1 -fam. N' <br /> 3. Lot Size home, motel, etc.) FOR COMMERCIAL USE 00 ../ <br /> .100. . . . . ft. x .106. . . . ft. 1 family Plans Submitted <br /> . . . . . . . . . . . . . . . . . . sq. ft. Plans Approved . . . . . . .�• <br /> - -------------- --- -- ^} <br /> S <br /> Ex55'r,nzi Fig. A. Location of proposed structures and � <br /> existing structures, well, sewage sys- 0 <br /> S <br /> SeT nLS tems, roads, etc., should be sketched 0 <br /> i in Fig. A. Include road setback, side s <br /> 0 ` ft' and back yard dimension and location 0. 0 <br /> I and setback from all bodies of water. <br /> If property is located at a highway in- T <br /> C � _ r tersection, show the intersecting high- F ;� <br /> 0 C- —�o �� p ways and the setbacks required along <br /> s1�O®p + them and at the intersection. <br /> o P <br /> a8r IP PERMIT FEES <br /> i <br /> 40 � '{ a _ Subdivision..... $25.00 + $2.00 per lot. <br /> 37 O Land Use................................. $10.00 <br /> E uildin ................................... 10.00 <br /> 3`} Sanitary .................................. 35.001 <br /> 63 �+ Well ........................................ 10.00 L <br /> J <br /> 307 Privy ....................................... 5.09 <br /> � �r <br /> =3441 lip <br /> :.. . .. �a..-a -.�1......... .. ..... . -�� <br /> .. <br /> Si a of Ow or Agent ate Zoning Administrator <br /> 4Inspection ate .......................................f......... Inspector ................................................................................................ <br /> Remarks .................................................................................................................... <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 />