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(J f l� ) <br /> Burnett,C�tinty Office of Zoning Administrator 9 0 _y z <br /> 0 0 <br /> tAPPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3` <br /> TO THE�ZONING ADMINISTRATOR: The undersigned hereby makes application for a _ o <br /> Permit for the work described and totaled as shown herein. The undersigned agrees that all <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 reyu a <br /> lations of-the.State of Wisconsin. . . O <br /> I ' A <br /> n n, 0 <br /> a Owner or Agent (please print) Contractor or Surveyor �� <br /> �� , 1V . c . . . . <br /> Address Address <br /> S �3U v 3 <br /> Ph!/a/n/j. ... . . .. ..�. . ... . ...... . ... . . . . . . . . . . . . . Phone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> PI m r - � Well'Driller ^\ �O <br /> y` <br /> rf4U <br /> 0i <br /> Address Address tl <br /> \�\ o <br /> S <br /> Phone . . . Phone <br /> R 0 <br /> 0 <br /> DESCRIPTION 4. Building Details 7. Sanitary Faci....es: ' v <br /> Type of Construction .No. Bathrooms o o i <br /> 1. Work -J. . c '� . . . . . . . No. Bedrooms ^ -- <br /> New Building . . . . . . Size ��. ft. x .?. �. ft. Septic Tank Size Gals. Q ' <br /> Addition Height . . . ..Stories . . . . . . <br /> 1 <br /> Sanitary Area a5 .K. .`. . . . 7a.Absorption Field Site: - R, <br /> Filling - . . . . . . �1 XSoil Type . . . . . . . . . . . . . . . . . . <br /> Moving 5. Permits Required Slope . . . . . . . . . . . . . . . . . . . . `! <br /> Grading . . . .-. . . Subdivision P.m. Rate . . . . . . . . ... . . . . . . . . 1 it <br /> Mobi.e Home Sanitary _C% ,Dry Well . . . . . . ('t�7 'r ? AIN ? I <br /> Privy. Building .—i. Seepage Trench . . . . . . <br /> Well . .J' Well !/ Privy <br /> Subdivision . . Other (Specify) . . . . . . Seepage Bed <br /> . . Cnndit:°nal <br /> 2. Classification � 9 Land Use `0' <br /> Zoning Dist '/'/ �. . _ - I ;(✓'i z�O <br /> G. Use (describe exactl 1 -tam <br /> 3. Lot Size home, motel,etc.) FOR COMMERCIAL USE - � ° <br /> . . h. x 'Plans Suhmitted - . . . } <br /> .1 . <br /> .V.✓. .O.G. .Js. sq. it. Plans Approved . . . . .. ;� (k" <br /> __________(___________ ______________________________--- <br /> ______ <br /> Fig. A. <br /> -� <br /> Location .of proposed structures and\ tet_ exist lew <br /> g structures, well, seage sys :� ° <br /> /`fni�•a :ems, roads, etc., should be sketched <br /> in Fig. A. Include, road setback, side ri-- <br /> _ and back yard dimension and location <br /> -JSr 'and setback from all bodies of water. i4 <br /> - 1 It property-is located at a'highway in- <br /> 1 //vl iersection, show the intersecting high <br /> pwsl�t ways and the setbacks required along 'Z-{� �I <br /> them and at the intersection. ?� <br /> PERMIT FEES <br /> Subdivision.....S25.00 + $2.00 per lot. <br /> Land Use:................................ 510.00 <br /> m 10.00 K <br /> DS14�f- <br /> ✓................:..........._....... 10.00 £ <br /> S-"ub ce*k............................. .1,5.60 <br /> Privy .....:......................... ....... 5.00 <br /> . <br /> gnatu a Owner or A9c r - D e 1 om ry Adm mrstr alar �, <br /> I nspecLon Dan ..... .. ... ... ..... Inspector - ._c.. _ . ...._ ..._ ...i <br /> Remarks ....... ......................- <br /> ' ..:.............._.__.._'._................._....L............_......_................ -- <br /> ............................ .._.........................:... ............ .......................... ............ <br /> . <br /> NOTE: A preliminary site.inspection must he made and site approval granted on all structures involving sanitary faciilitie! <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must-be attached tc <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 In 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 />