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C-07//6,1 <br /> Burnett County Office of Zoning Administrator N o - z <br /> CD CD d 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT ° 3 c <br /> TO THE. ZONi-i\IG ADMINISTRATOR: The undersigned hereby makes application for a --I - o <br /> Permit for the work described and located as shown herein. The undersigned agrees that all y �1 <br /> work shall be done in accordance with the requirements of the County Zoning Ordinance, m <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- v a <br /> lations of the State of Wisconsin. 3 a <br /> d <br /> 1.\4 <br /> ri CD <br /> Owner r Age t p ase print Contr:cto� Surveyo/49e,77A ... <br /> fir H •\ `� <br /> CD (` <br /> CD 1 <br /> Address Address <br /> C. <br /> Phone Phone fw <br /> Plumber Well Driller <br /> • <br /> 0 .\ <br /> Address Address CD G) : <br /> C) • <br /> •+ < <br /> o ,.. \ <br /> Phone Phone CD y r <br /> 0 , o <br /> CD o <br /> D ESC R I PT ION 4. Building Details 7. Sanitary Facilities: -o <br /> Type of Construction No. Bathrooms o z 43r <br /> 1. Work No. Bedrooms . 'V` <br /> New Building Size ft. x ft. Septic Tank Size Gals. c• -Z <br /> Addition Height Stories <br /> Sanitary Area 7a.Absorption Field Site: r <br /> Filling Soil Type o <br /> Sloper+ <br /> Moving 5. Permits Required / <br /> Grading Subdivision (/ Perc. Rate <br /> Mobile Home Sanitary Dry Well -n m <br /> Privy Building Seepage Trench fD CD <br /> 69 <br /> Well /' Well Privy <br /> Subdivision . .(,/ Other (Specify) Seepage Bed o `\�j <br /> Conditional <br /> o N <br /> 2. Classification / Land Use <br /> h <br /> Zoning Dist. C CD <br /> �� a • <br /> " <br /> o <br /> 6. Use (describe exactly, 1 -fam. H' <br /> 3. Lot Size home, motel, etc.) F=OR COMMERCIAL USE o • <br /> ft. x ft. Plans Submitted <br /> sq. ft. Plans Approved <br /> Fig. A. <br /> Location of proposed structures and <br /> existing structures, well, sewage sys- 0 <br /> tems, roads, etc., should be sketched -.. n <br /> in Fig. A. Include road setback, side SU T <br /> and back yard dimension and location .9-) •o. <br /> 11 and setback from all bodies of water. ! <br /> If property is located at a highway in <br /> tersection, show the intersecting high- C.' DVjilyn �� <br /> ways and the setbacks required along UJ U,) I� <br /> them and at the intersection. t <br /> • l�J PERMIT FEES `' 1 <br /> 4. <br /> Subdivision $25.00 + $2.00 per lot. fD <br /> Land Use $10.00 . r-• <br /> Building 10.00 y <br /> Sanitary 20.00 \ <br /> Well 10.00 `'\ <br /> Septic Tank 10/5:" <br /> Privy 5.00 <br /> 9 <br /> /117/ <br /> Signature of Owner or Agent Zon' A dministrator <br /> Inspection Date Inspector <br /> Remarks <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 />