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_ . <br /> Office of Zoning Administrator <br /> Burnett County N o z <br /> Co v o o <br /> APPLICATION 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 located as shown herein. The undersigned agrees that all <br /> e done in accordance with the requirements of the County Zoning Ordinance, X, � <br /> work shall b •�1 <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- CD <br /> ( : <br /> latio. of the State of Wisconsin. o- U O <br /> 1 . <br /> CD <br /> Owner or Agent (please print) Contractor or Surveyor <br /> J/Z CD <br /> 0 <br /> �Jr . . . . . . . . . . . <br /> AddresJ � �/v Address a - <br /> 7 cD \ <br /> C�• . . . . . . . . . . . . . . . . . . <br /> Phon Phone <br /> Plumber Well Driller <br /> all <br /> . . . . . . . . . . . . . : . . . . . . . . . . . . . . . . . . <br /> Address Address ' <br /> �o <br /> 5 6 3 -233J A <br /> 377 y �.� <br /> \ r <br /> Phone . . . . . . . . . . . . Phone, N <br /> CD o : <br /> DESCRIPTION 4. Building Details7. Sanitary Facilities: <br /> Type �f Construction No. Bathrooms z U o o CDo <br /> 0 I <br /> 1. Work . . . . . . . No. Bedrooms -3 • • • i i <br /> New Building . . . . . . Size ft. x .7. . . ft. Septic Tank Size Gals. /. DDD r <br /> Addition Height . . . . . Stories - . . . . . . . . . <br /> Sanitary ✓ Area 7a.Absorption Field Site: :00 <br /> Filling . . . . . . Soil Type . . . :9j ° I <br /> Moving . . . . . . 5. Permits Required Slope • • •_•.• • • • • • • • • • • • • • • • <br /> Grading . . . . . . Subdivision . . Perc. Rate <br /> fi m <br /> . Mobile Home . . . . . . Sanitary !I/ •' Dry Well . . . ... . CD <br /> Privy Building • ; Seepage Trench . . ... . . fD <br /> WellWell ✓. . Privy. - <br /> V <br /> Subdivision . . . . . . Other (Specify) Seepage Bed . . off, <br /> Conditional . . . . . . o o cn cn <br /> 2'. Classification Land Use . . . . . ., s <br /> 99 <br /> Zoning Dist. !1'a o <br /> 6. Use (describe exactly, 1 -fam. : y <br /> 3. Lot Size home, motel, etc. FOR COMMERCIAL USE f <br /> ft. x . . ft. 5117 , Plans Submitted :( ,W <br /> . . . . . . . . . . . . . . . . . . sq. ft. Plans Approved . . . - <br /> v1 <br /> ----------------------------------------------------------------- <br /> Fig. A. Location of proposed structures and <br /> existing structures, well, sewage sys- : o, <br /> tems, roads, etc., should -be sketched <br /> in Fig. A. Include road setback, side <br /> and back yard dimension and location <br /> and setback from all-bodies of water. : ( <br /> If property is located at a highway in- <br /> tersection, show the intersecting high- .\ <br /> ways and the setbacks required along <br /> them and at the intersection. : . <br /> .PERMIT FEES <br /> Subdivision..... $25.00 + $2.00-per lot. ." <br /> La Use................................. $10.00 A� <br /> Building ................................. 10.00 <br /> Sanitary .................................. 35.00 1 <br /> Well ..................................... 10.00 <br /> Privy ....................................... . 5.00 <br /> ............. ............ ............ ...................... oaf............. . .. .... . ......................... <br /> Signature of Owner or 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 face <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attach <br /> this application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any kl <br /> in g until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed <br /> with is found to exist. Changes in plans or specifications shall not be made without approval of the Zoning Adm inisti' <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND A-PPROVED.! <br />