2014/10/23 - LAND USE - LUP - Other

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Burnett.0 moty Office of Zoning Administrator c 'o PPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT -3 3 TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a -i Permit for the work described and located as shown herein. The undersigned agrees that all work shall be done in accordance with the regalrements of the County Zoning Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and ragu IrV lata ns of the State of Wisconsin. c , pp 3 O�wnn(eerrr or-Agcn (please print) / _. Contractor or Surveyor n c Address - � Address G G - r, _ . . _ S Phone . . . . . . . .�. . . . . . . . . . . . . . . . Phone ' ' I (b Plumber. . . . . . . . . . . . . . . . . . . . . . . . . . Well Driller. . . . . . . . . . . . . . . . . Address - � � � � � � � � � - � � � Address b .» Phone . . . . . . . . . . . . . . . . . . . . . . . . .Phone . . . . . . . . . . . . . . . . ... . . . . . . . . . . m m 0 E DESCRIPTION 4. Building Details 7. Sanitary Facilities: - Typs of Construction No. Bathrooms o z o " a' 1, Work .G re!"r C:_ . . . No. Bedrooms . . . . . . P New Building _ . . S- ..1 �t x -Z y It. Septic Tank Size Gals. Addition Height "/. Stores L - Sanitary . . . Area ]a.Absorption Field Site: . 1 Filling . . . . Soil Type . . . . . Moving ' . . 5. Permits Required Slope . . . . Grading . . . . . . Subdivision Pena Rate . . . . . . . . . . . . . .`:. . Monde Home . . . . . Sanitary . . . . .'. Ory Well . . . . . Privy . . .--. Building Seepage Trench Well . : . .-. . Well . . . . . . Privy .. . . . . . '�' Subdivision Other (Specifyl . . . . . . Seepage Bed . . . . . . o Conditional . . . . . p., m s 2. Classification - Land Use S Zoning Dist - ... . . . . Y 1� is . 6. Use (describe exactly, 1 -fam. - 3. Lot Size d+ home,motel, etc.) FOR COMMERCIAL USE ° . .�� . . ft. Plans Submitted . . . . sq. ft. - Plans.Approved 1i i W y Ful_A. Location of proposed structures and C. ry existing structures, well,- sewage sys ,co terns, roads, etc., should be sketched t 3 :L n Fig. A. Include road setback, side .� ' ��ZA S and back yard dimension and location LS fand setback from all bodies of water. t\ I - If property Is located st a highway 4 s, tF /lows tersection, show the -intersecting high U. 1 ways and the setbacks required along bro - them and at the intersection. ! � _ STI PERMIT FEES _ Subdivision..... $25.00 + $2.00 per lot. iO n, . . Land Use:................................ $10.00 ^Q Buildln : u .y ` \ g....:............_................ 10 i9d '::;I�1 • _ - Sanitary ..... 20.00 r Well ................... ............ 1D.DD .�C U SepticTank .......... ...... ......... - 10.00 1 �/ ?d✓n Privy ...._........._........ _......_ 5� ...... f r ' bate e $ gnatu re of Desire, Age Z g Administrator Inspection Date ......... __. . .... I tspector .. ....... ... . .... ... ._. .... Remarks ___. .................... .......... _. _. . .-.....:_ ........ .. ...._......... ........_._. .. _.............. __........._. ............................. NOTE: A preliminary site inspection must be made and site approval granted on all structures involy- 9 sa lay ry Iacili ties before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test rrst be attached to this application before a Permit will be issued. Do not purchase, or Install a septic tank; do any plum bi tg o sta ct any build ing until a permit has been issued. A permit may he revoked if m srepresenta Con of any of the information conveyedhere- with is found to exist. Changes in plans or specifications shall not he made without approval of the Zoning Administrator SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED.