2016/01/11 - SANITARY - SAN - Other

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Burnett County > Office of Zoning Administrator N O --1 Z m m m ° o APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a o Permit for the work described and located as shown herein. The undersigned agrees that all H work shall be done in accordance with the requirements of the County Zoning Ordinance, 27 Sanitation Code, and with all other applicable County Ordinances and the laws and regu- -0 ° lations of the State of Wisconsin. 3 a O �0 $gxnazd. kf... Brown. .(f1.F.. Brown). . (� = = Owner or Agent (please print) Contractor or SuAA'POMPUTEWSCANNED 2087 Cornell Dr. New Brighton, MN 55112 a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Address Address 612-760-1787 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - Phone Phone Donald Daniels Plumber Well Driller p Siren, WI 54872 . . . . . . . . . . . . . . . . . . . . . . . . Address Address o n 349-5364 or 463-2333 o' Phone :� . . . . . . . . . . . . . . . .Phone. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . m ° 0 � o DESCRIPTION 4. Building Details 7. Sanitary Facilities: Type o� truction No. Bathrooms 1• • o Z °° 1. Work `-`FZ No. Bedrooms 2. . . . o ;r New Building Size . . ft. x . . . . . . ft. Septic Tank Size Gals. 75.0 . U Addition . . . . . . Height . . . . . Stories . . . . . . . . . . . . Sanitary X. . . Area 7a.Absorption Field Site: Type Filling . . . . . . Soil T YP . . . . . . . . . . . . . . . . o Moving . . . . . . 5. Permits Required Slope . . . . . .tcycl ; Grading Subdivision Perc. Rate . Mobile Home Sanitary X , Dry Well . . . . . . n Privy Building Seepage Trench D m Well . . . . . . Well . . . . . . Privy . . . . . . a 1 Subdivision . . . . . . Other (Specify) . ., . . . Seepagge Bed X. Conditional 3S X 12 4 U) N c 2. Classification _ Land Use 420 sq. ft. a Zoning Dist .P/� o 6. Use (describe exactly, 1 -fam. I y 3. Lot Size home, motel,etc.) FOR COMMERCIAL USE . , ft ft. sdogle family cabin Plans Submitted <\ v` /D :(l✓. . . . . sq. ft. Plans Approved PP `� -------------------------------------------------P P------------ vO:" Fig. A. Location of proposed structures and existing structures, well, sewage sys- o tems, roads, etc., should be sketched in Fig. A. Include road setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway in- tersection, show the intersecting high- ways and the setbacks required along them and at the intersection. PERMIT FEES Subdivision.....$25.00 + $2.00 per lot. Land Use........................... $10.00 Building................................... 10.00 Sanitary .............................0.... 20.00 Well ........................................ 10.00 Septic Tank ......................0..... 13MM od Privy ....................................... 5.00 ..._........... . ... . .................... //YVO....... ! . .... %.... Signature of Owner or Agent 9 Administrator 2 , Inspection Date j. a/ c�D•........................ Inspector . .......... .... .. . ........................................ Remarks ................................................................................................................................................................................................ ....................................................................................................................................................................0............0.............. NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to this application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build- ing until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- with is found to exist. Changes in plans or specifications shall not be made without approval of the Zoning Administrator. SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED.