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Burnett County Office of Zoning Administrator o -1 Z <br /> W 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for ao bJ <br /> Permit for the work described and located as shown herein. The undersigned agrees that all ;O <br /> work shall be done in accordance with the requirements of the County Zoning Ordinance, <br /> and regu- <br /> Sanitation Code, and with all other applicable County Ordinances and the laws <br /> (y\� <br /> lations of the State of Wisconsin. 3 -^^� O <br /> C m 1 i o <br /> Robert Wa aer _ <br /> Owner or Agent (please print) Contractor or Surveyor <br /> 13009 Uptori Ave. S. <br /> Address Address n� <br /> Bur:.sville, Flit 55337 <br /> . . . . . . . . . . . <br /> . . .one. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Phone. . . . . . . . . . . . . . . . . . . . . . . <br /> Ph <br /> .d <br /> Do ald D aiels <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \ :� <br /> Plumber Well Driller <br /> Sire.i, WI 54072 <br /> 0 <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \ _. <br /> :c <br /> Address Address �^ L) ' <br /> o <br /> 715-463-2333 or 349-5364 <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> Phone Phone t,,, <br /> I n o <br /> � o <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: <br /> Type of ConstructionNo. Bathrooms 1• �,� o Z -oo <br /> 1. Work . . . . . j) . . `' No. Bedrooms . .3- - 0 <br /> New Building . .x. . . Size .4.7P. ft. x . .7.f! ft. Septic Tank Size Gals. 1000' '., 7 <br /> Addition . . . . . . Height . . . . . Stories . .{ . . . . . . . . . <br /> Sanitary . .,Y. . . Area . . . . . . . . . . . . . . . , , , , 7a.Absorption Field Site: <br /> Soil Type . . . . . . . . . . . . . . . . . . <br /> Filling . . . . . . <br /> Moving . . . . . . 5. Permits Required Slope . . . . . . . . . . . . . . . . . . . . <br /> Grading . . . Subdivision . . . . . . Perc. Rate . . . . 3. . .3. . 3. . . . . T :� <br /> Mobile Home . . . . . . Sanitary . .x. . . Dry Well . . . . . . <br /> Privy . . . . . . Building , ,x. , . Seepage Trench . . . . . . ;C, :U <br /> Well .x. . . . Well Privy <br /> .x . . . . . . <br /> Subdivision . . . . . . Other (Specify) . . . . . . Seepage Bed . .x. . . <br /> Conditional . . . . . . <br /> 2. Classification �� Land Use Cr » <br /> c � <br /> Zoning Dist. . . ° <br /> A 4 6. Use (describe exactly, 1 -fam. <br /> 3. Lot Size home, motel,etc.) FOR COMMERCIAL USE 0 <br /> . . . .uQ. . ft. x .$00, , , , ft, si..igle family Plans Submitted . . . . . 0 <br /> . . . . . . . . . . . . . . . . . . sq. ft. cabi.: Plans Approved . . . . . . <br /> --------- ------------------- <br /> Fig. A. Location of proposed structures and <br /> existing structures, well, sewage sys- 0 <br /> tems, roads, etc., should be sketched F <br /> in Fig. A. Include road setback, side <br /> and back yard dimension and location 'a <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 /> v <br /> PERMIT FEES n <br /> Subdivision..... $25.00 + $2.00 per lot. <br /> Land Use................................. $10.00 :Cj\ <br /> wilding . u.-tcl�+-raSen <br /> Sanitar ... �' ...... <br /> Wel ........................................ 10.00 <br /> Privy ....................................... 5.00 <br /> ...>�/...:'..:'..i9............ . . . ........9.................... ................................ ......... ...:..............� .t'ra't........................ <br /> Si nature of Owner or A ent Date Zonin Administrator <br /> Inspection Date . .:.1�.::'.l may....................... Inspector ..,&.... ..... . ...ed............................. <br /> Remarks .C-........P-�.................................................................................................................... <br /> ................................................................................................................................................................................................ <br /> ................................................................................................................................................................................................ <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 />