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.,r - __ <br /> r <br /> Burnett Ciounty _ •" Office of Zoning Administrator m v .Q Z <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT a, 3 P <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a = o <br /> t Permit for the work described and located as shown herein. The undersigned agrees that all x '" <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- A c, sYs' <br /> latices MmAVVI�oin�� <br /> of the Sta a of Wisconsin. 3 d iO Contractor or Surveyor \� <br /> may/ <br /> Address // Address c ���w <br /> i <br /> i <br /> A � <br /> Phone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . o <br /> Phone Phone <br /> Plumber Well Driller \ <br /> Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Address . . . . . . . . . . . . . . . . . . . . . <br /> �V9 O <br /> Oh <br /> . . . . . . . . . . . . . . . . . . . . . . m <br /> Phone Phone '^ � <br /> 0 <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: _ D 9 <br /> Type of Construction No. Bathrooms o z <br /> 1. Work . . . . . . . . . . . . . . . . . . . . . . No. Bedrooms ° <br /> New Building Size ft. x . . . . . . It. Septic Tank Size Gals. <br /> Addition Height . . . . . Stories . . . . . . .. . . . . �� [ <br /> Sanitary Area . . . . . . . . . . .. . . . . . . . ]..Absorption FI Id <br /> Filling y . . . . . . Soil Tyne <br /> Moving . . . . . . 5. Permits Required Slope .. . . : ryi 1 <br /> Grading . . . . . . Subdivision Parc. Rate . ./.7 l. . . . . . . ° G <br /> Mobile HomeSanitar y . y Dry Well <br /> . . ' � � " � <br /> Privy . . . . . . Building . . . . . . Seepage Trench <br /> Well . . . . . . Well . . . . . . Privy <br /> Seepage Bed G>'U.X( <br /> Subdivision Other Zonal y) . . . . . . :-� <br /> _ JJ � oZ <br /> Conditional . . . . . . \ <br /> 2. Zoning <br /> . . . Land Use . . . . . . 1 rr n <br /> Zoning Dist !!��!!YYII a ^ <br /> 6. Use (describe exactly, 1. fam. <br /> 3. Lot Site home,motel,etc.) FOR COMMERCIAL USE <br /> . . ft.x . . . . ft. Plans Submitted <br /> . . . .. . . . . . . . . . . . . . <br /> . . . . . . . . . . . . .. . . . . sq. ft. Plans Approved . . . . . . <br /> Pp it <br /> ------------------------------------------------------------------ <br /> 9 Location of Proposed structures and i <br /> existing structures, well, sewage sys- ?J ' o <br /> tems, roads, etc., should be sketched ' F <br /> in Fig. A. Include road setback, side <br /> r and back yard dimension and location <br /> / <br /> and setback fromall bodies of water <br /> loc . <br /> If property is located at a highway in � <br /> tersection, show the intersecting high �ry}" <br /> ways and the setbacks required along v s _ZN <br /> them and at the intersection. ? i <br /> urrU'f PERMIT FEES <br /> HIL C Subdivision.....$25.00 + $2.00 per lot. xi <br /> �srp yn J CBO �5 beL`fi' Land Use................................. $10.00 <br /> J�M T3-"r\ + <br /> ✓ V/�"' 5{,{ h r\ Building......................._.......... 10.00 t <br /> Pe tidv hIS Y2P1a ���Sanitary .................................. 20.00 <br /> e5yJev Well ........................................ 10.00 <br /> q'91) '"s , Septic Tank .. . .. .................... 10.00 •1 I <br /> 2ema� �ltn a 50 �y w S Privy ....................:................. . <br /> re500 <br /> f <br /> Eu�eAO;vv�1 ' ,`�'-,qq` .........._. ..Zr-:./.-1-741 <br /> ner orient / ate omn' g Administrator <br /> Inspection Date-:. '30-............:................. Inspector /./!I!:'�..'�Cw/® ( �......� ..........._� <br /> Remarks - ' <br /> i <br /> ...............................................................................................................................................................................:......... <br /> ..........................................................:.......................................................................................... <br /> .................................... <br /> NOTE: A preliminary site-inspection must be made and site approval granted on ail structures involving sanitary faci <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attach, <br /> this application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any y li <br /> ing until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed) <br /> with is found to exist. Changes in plans or specifications shall not be made without approval of the Zoning Adm inistr <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED.;' <br />