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Burnett County Office of Zoning Administrator y -p /o -1 Z <br /> APPLICATION FOR SANITARY — LAND USE BUILDING PERMIT ° ° 0 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a C \ o <br /> Permit for the work described and located as shown herein. The undersigned agrees that all _ d <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- v n <br /> lations of the State of Wisconsin. - <br /> 6c7�.e r. . �. . . . . . .C2 �n� r <br /> \ 3 d h O <br /> st <br /> Owner or Agent (please print) Contractor or SurveyorN \ ° <br /> C yU <br /> mak. . ria. . Gc� t�.- <br /> dd . . . . . . . . . . y�93. . n <br /> Address <br /> Address - — <br /> a <br /> m <br /> Phone .P. .one. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> h <br /> i <br /> r.�?f F t <br /> Plumber . . . Well Driller <br /> ly <br /> 1. _J lard, � S�1�.�0. . . Y <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> Addressy. O <br /> Address " � n o <br /> p <br /> Phone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . � <br /> Phone <br /> m r <br /> n o <br /> DESCRIPTION 4. Building Details ° <br /> 7. Y Sanitar Facilities: . <br /> Type of Construction No. Bathrooms . Z Z o <br /> 1. Work . . . . 1 �j?l;Z:. . . ... . . No. Bedrooms <br /> New Building . . . . . . Size .444. . ft. x . . :2 ft. Septic Tank Size Gals. <br /> Addition Height Stories . . . . . • _4QZ=0_1 :N <br /> Sanitary, . .t/, . Area 7a.Absorption Field Site: 'r <br /> Filling . . . . . . Soil Type . . . . . . . <br /> Moving . . . . . . 5. Permits Required Slope . . . . . . . . ... . . . . . . . <br /> Grading . . . . . . Subdivision . . . : Perc. Rate . . . . . . . . . .�'. . . . <br /> Mobile Home Sanitary . , X, Dry Well . . . . . . T <br /> Privy . . . . . . Building Seepage Trench ? <br /> Well . .E;i! :. . . • . . . <br /> Well • • Privy fn <br /> Subdivision Other I(S ecif Seepage Bed ppL <br /> (Specify) . . . . . . See P 9 1&23 art I i <br /> Conditional <br /> 2. Classification \° :Z <br /> Land Use . . . . <br /> Zoning Dist. . .. .. . <br /> a <br /> o <br /> «a 6. Use (describe exactly,Em. <br /> -fam. <br /> 3. Lot Size ,etc.) FOR COMMERCIAL USE N <br /> _34k:?. . . ft.x ..39.0. . ft. Plans Submitted ° <br /> • ��.�.���. . sq. ft PlansA roved . . . . . . �. i <br /> PP . <br />-——————————————— <br /> Fig. A. Location of proposed structures and - <br /> existing structures, well, sewage sys- ° }�. o <br /> tems, roads, etc., should be sketched <br /> N <br /> in Fig. A. Include road setback, side � <br /> and back yard dimension and location <br /> and setback from all bodies of water. <br /> siJ h r 1t� If property is located at a highway in- <br /> /tl tersection, show the intersecting high- <br /> Q1, <br /> ways and the setbacks required along <br /> them and at the intersection. <br /> Co- PERMIT FEES <br /> r <br /> Subdivision..... $25.00 + $2,00 perlot, <br /> Land Use................................. $10.00 `\ <br /> Bu'I din g................................... 10.00 1 <br /> (San <br /> i ary .................................. 35.00 <br /> ell ..................................... 10.00 <br /> Privy ....................................... 5.00 <br /> ffY 6v <br /> �.. . . .. <br /> Q `� 7 <br /> .1... . . �-0.. .................... <^ .......................................... <br /> Signature of Owne Agent Date Zoning Administrator <br /> InspectionDate ................................................ 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 />