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Burnett County Office of Zoning Admin straor �1Ctir <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT A c <br /> 3 0 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application fora o <br /> Permit for the work described and located as shown herein. The undersigned agrees that all m <br /> work shall be done in accordance with the requirements of the County Zoning Ordinance, 'y <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu. v a t^1 <br /> lations�f the State of Wisconsin. 11 <br /> .�Y.�. .�/L= <br /> Ow er or Agent (please print) ontractor r urveyor ; <br /> H <br /> /� L <br /> Ln <br /> Address / Address — - <br /> PhonePhone. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> . . . . . . . . . . . . . . . . . . . . . . <br /> .Plumber . . ,t . J. .. . . . . . . . . . . . . . . . . . . <br /> Well Driller V <br /> Address . . . . .ss. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> Addre <br /> 0 o <br /> ^. < <br /> honePhone N m <br /> o <br /> A a <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: v <br /> Type of Construction No. Bathrooms . . . . . . Z Z o <br /> 1. Work �1'# � . . . . . ./mq No. Bedrooms . . . . . ° o ^� <br /> New Building . . . Size 199. . ft. x xp. . ft. Septic Tank Size Gals. . . . . . . :_ <br /> Addition . . . Height . . . . . Stories .( <br /> Sanitary . . . . . . Area . . . . . . . . . . . . . . . . . . . 7a.Absorption Field Site: <br /> Filling . . . . . . Soil Type lj 0 <br /> Moving 5. Permits Required Slope <br /> Grading . . . . . . Subdivision Perc. Rate <br /> Mobile Home . . . . . . Sanitary , . . • Dry Well m m <br /> . . . . . . <br /> Privy . . . . . . Building .X, , . Seepage Trench . . . . . . m fD <br /> Well . . . . . . Well Privy '.4fA <br /> Subdivision <br /> Other (Specify) . . . . . . Seepage Bed . . . . . . o ;� <br /> C, <br /> Conditional <br /> 2. Classification Land Use . . . . <br /> v <br /> Zoning Dist. . . . . . . a – <br /> 6. Use (describe exactly, 1 -fam. – o� <br /> 3. Lot SizeY_ home, motel,etc.) FOR COMMERCIAL USE ' <br /> .�Q.O. . ft. x///�0. ! Oft. /C49Z/1 _ 46400- Plans Submitted . . . . . . <br /> . . . . . . . . . . . . . . . . . . sq. ft. arcAd-/yo W'tTr4 Plans Approved <br />------------------------ <br /> "r`.�'QQ•, p i Fig' A' Location of proposed structures and <br /> existing structures, well, sewage s s- o <br /> ms, roads, etc., should be sketched <br /> in Fig. A. Include road setback, side � <br /> and back – <br /> ' mss, yard dimension and location <br /> and setback from all bodies of water. o:•e <br /> If property is located at a highway in- .I <br /> �1J� --�NoeTh tersection, show the intersecting high- <br /> waysand the setbacks required along <br /> them and at the/ intersection. q\7LYL s V ¢ i�1C1 <br /> PERMIT FEES <br /> r Subdivision $15.00 m <br /> Land Use . . . . . . . . . . . 1 0 <br /> Building . . . . . <br /> Well <br /> Sanitary <br /> Iltary . . . . . . . . . . . 10.00 [_RI <br /> 5.00 (� <br /> I Septic Tank 1.00 C <br /> Combination Building, Sanitary <br /> d ; and Well . . . . . . . . 15.00 <br /> Privy . . . . . . . . . . . . 5.00 <br /> .........../ � - . .................... ... $1x7........ .. ..... .. rmi.. ... . ... . . . .. . . .ofOwner or Agent Date ning istrator <br /> Inspection Date .... ................. Inspector ............ ....... ..... ........... .... ........... <br /> Remark <br /> (... ................................................................................................................................. .......I..... <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 he 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 />