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Burnett County Office of Zoning Administrator -(--51-"Nr":1:11P1 z <br /> CD CD m 0 o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT * i <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a H -, o <br /> Permit for the work described and located as shown herein. The undersigned agrees that all .ca "� <br /> work shall be done in accordance with the requirements of the County Zoning Ordinance, i Q <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- -o a N <br /> lations of the State of Wisconsin. -' a 5'' :ice 0 <br /> 8 d t <br /> nn FF 77 _;V <br /> Owner cflq Qple�dsb pP'iryt RSON Contractor or Surveyor z,--", cv <br /> �f <br /> RT. 1 FREDERIC , WI S�S�3'1 a ?.,� <br /> Address Address a <br /> 689-2333 ;� T-(•,1 <br /> Phone Phone \ D <br /> ' h <br /> Plumber Well Driller <br /> in <br /> o \ <br /> Address Address c C.) <br /> �7 o ,. <br /> Phone Phone m " m <br /> 0 ,, 0 <br /> m 0 h <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: NONE -a <br /> Type of Construction No. Bathrooms o z �° J <br /> 1. Work FRAME No. Bedrooms NONE o <br /> New Building Size .14. . ft. x .16. . . ft. Septic Tank Size Gals. . . N.QNE <br /> Addition XX. . . Height .8. .F.TStories . .1 . . . <br /> Sanitary Area .22.4 • SQ. FT. • . . 7a.Absorption Field Site: � ~� m <br /> Filling Soil Type o <br /> Moving 5. Permits Required Slope <br /> Grading Subdivision Perc. Rate ci. Ca- <br /> Mobile <br /> Mobile Home Sanitary Dry Well 71 CD C ;� <br /> Privy Building Seepage Trench fD CD V:, 1" <br /> Well Well Privy <br /> n., <br /> o <br /> Subdivision Other (Specify) Seepage Bed o <br /> Conditional <br /> Cl') <br /> o C , <br /> ` cn <br /> c CD <br /> 2. Classification Land Use r A o. ° <br /> Zoning Dist. A . . . . a o <br /> 6. Use (describe exactly, 1 -fam. .� y' <br /> ° <br /> 3. Lotze ACRES home, motel,etc.) FOR COMMERCIAL USE ° <br /> ft. x ft. tL (`LG Ai(re: Plans Submitted `I ° <br /> sq. ft. Plans Approved t'., <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 /> ' ADO. ,' and back yard dimension and location a' <br /> and setback from all bodies of water. C?, <br /> If property is located at a highway in- w <br /> )��/ o ' , tersection, show the intersecting high- i <br /> Ni <br /> /— t.i5rINCr- t419V ways and the setbacks required along <br /> them and at the intersection. U <br /> PERMIT FEES <br /> Sh'TW Subdivision $25.00 + $2.00 per lot. O fD <br /> � oa T11•104 Land Use $10.00 <br /> P° Building Building 10.00 • <br /> Sanitary 20.00 �_.\ <br /> Well 10.00 <br /> Septic Tank 0/5_. Oa 3 <br /> If A.A.( it Rt� Privy 5.00 <br /> lei ifite, r 4(1-6e,".: <br /> date/ .‘7,,.e.:. e..-t..,e...-- /0 -2 &- 79 <br /> Signature of Owner or Agent Date d Z. . Administrator <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 />