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Burnett County Office of Zoning Administrator v° to 9 0. /' <br /> 0 <br /> APPLICATION FOR SANITARY — LAND,USE — BUILDING PERMIT 3 A 1i� 1 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a = o V <br /> Permit for the work described and located as shown herein. The undersigned agrees that all <br /> work shall be done in accordance with the requirements of the County Zoning Ordinance, z n <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and r.go a n f'J3 (�V <br /> lations of the State of Wisconsin. 3 O <br /> Owner or Agent bo lease pnnq Contractor or Surveyor N ;O <br /> c <br /> SG-s-.Orr,5. . .441 . . . _ . . . . . . . . . . � :. !3u.. . <br /> Address Adtl cess j cL iV <br /> . . . . . . . . . . . . <br /> ' i <br /> Phone <br /> �l.I. . r /IO�I�I�. r. . . . . . . Phone. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . �ff``\\. :� <br /> Plumber s Well Driller <br /> .< <br /> Address Address <br /> Phone Phone •�^ <br /> 0 <br /> DESCRIPTION 4. Building Details 7, Sanitary Facilities: o v <br /> Type of Constru inn No. Bathrooms o Z n <br /> 1. Work yy. . . . .[ `U.. . . .. ... fir'"" No. Bedrooms ° <br /> New Building . . .'.\ . Sure .mac, ft. it. Septic Tank Size Gals. <br /> Addition o Heigh �or <br /> Sanitary . . Area . . . . . . $CSO. . . . . . . ]a.Absorption Field Site: <br /> Filling . . . . . . Soil Type . . . . . —:5A--?/' o <br /> Moving . . . . . . 5. Permits Required Slope . . . . . . . .'5. {0.7C--7 Q\ <br /> Grading . . . . . . Subdivision Pere. Rate . . . . . . . . ..7 . . . . . 'C <br /> Mobile Home Sanitary , , A', Dry Well <br /> X Seepage Trench ' ^ <br /> Privy Building ' rn 0 <br /> Well . . )1. Well . . . Privy . . . <br /> Subdivision . . . . . Other (Specify) . . . . . . Seepage Bed d! 3� 0 1I�� <br /> Conditional . . . . . . to <br /> 2. Classification l"sr ) n <br /> Land Use . . . . . . � ' Q <br /> Zoning Dist.• . . . . . . <br /> 6. Use (describe exactly, �--f-m:. <br /> 3. Lot iz home, let,etc.l FOR COMMERCIAL USE ° <br /> $ . <br /> .7J(� it.x SOD ft. Plans Submitted <br /> sqPlans Approved <br /> __ _----- __._ ---- _______ _ __ __ _ <br /> __Fig.A. <br /> tngnstoructuresproposed <br /> well, uctures and <br /> o <br /> teras, roads, etc., should be sketched FI <br /> SyL{ I I in Fig. A. Include•road setback, side <br /> I and back yard dimension and locationV 1oj <br /> and setback from all bodies of water. <br /> It property is located at a highway in <br /> `I 40• tersection, show the intersecting high <br /> fySzL IC'y44' ways and the setbacks required along <br /> them and at the Intersection. <br /> �num <br /> \. GOf\ I PERMIT FEES <br /> ;bdivisionS4 SRO <br /> Land Use . . . . 1.00 <br /> a Building <br /> Sanitary fdV 1�'9® E$li'G' p� <br /> Well . . . . f.Q 5.00 <br /> I(btyr I �1 Septic Tank �Q <br /> 70 2Ur Combination Building,. ry <br /> •V and Well <br /> Privy... .. . . . ./. . ZOO i <br /> Si nature of Ow oLen Date Z in. <br /> n min rstrator I <br /> Inspection Date _ ..l.Z.........,.z.F......... inspector .f...��z:ff..� y... .�'1.... .�-ES.,.^....:........:_..... ...I <br /> Remarks ...C.{y./l...f.' .... -fl..Z- P.. -................ ............................:...'............................... <br /> ......................................................................................................................................................................................... <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involvingsanitary,faciliti! <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached <br /> this application before a permit will be issued. Do not purchase or install a septic tank, do any Wool or start any <br /> buili <br /> ing until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed,heri <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. \I <br /> - - - <br />