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Burnett County Office of Zoning Administrator N -0 o Z <br /> d o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application fora F) ;" o <br /> Permit for the work described and located as shown herein. The undersigned agrees that all H <br /> work shall be done in accordance with the requirements of the County Zoning Ordinance, �c <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- a <br /> lations of the State of Wisconsin. o p <br /> Owner or Agent (pleasLprint) Contractor or SurveyorrZ <br /> Fd <br /> C <br /> cL <br /> Address rj^� P AU Address 0- <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> Phone ^ Phone (_ <br /> Plumber Well Driller \G:� <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .A. . <br /> ddre. .ss. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . n o <br /> Address � G) :A <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> Phone Phone 0 <br /> � o <br /> o <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: ' ° <br /> Type Construction No. Bathrooms o Z °0 <br /> . . . . <br /> 1. Work y / "'4^' . . . . . . No. Bedrooms a' P o M <br /> New Building . . .tom. Size �{ . ft. x . .�� ft. Septic Tank Size Gals. . . . .Add [ \, , <br /> Sanitary : : ._. ./ Height . _ ... Stories . . . . . . 7a.Absor tion Field Site: 7 :v��v � <br /> Sanitar (,l Area p <br /> Filling . . . . . . Soil Type '� o <br /> Moving . . . . . . 5. Permits Required Slope \�) ' <br /> Grading . . . . . . Subdivision • • • Perc. Rate . . . . . . . . . . . . . . . . . <br /> Mobile Home Sanitary `� Dry Well . . . . . . <br /> Privy Building Seepage Trench <br /> Well . . . . . . Well _ Privy - S <br /> Subdivision . . . . Other (Specify) . . . . . . Seepage Bed 4,A c <br /> Conditional N to <br /> n c m <br /> 2. Classification UN Land Use . . . . . . a S3 <br /> Zoning Dist. <' 0 <br /> �� 6. Use (describe exactly, -fam. •�H: <br /> 3. Lot Size home, motel, etc.) FOR COMMERCIAL USE 0 <br /> ft. x ft. Plans Submitted . . . . . . - <br /> .�. �. . cf sq. ft. Plans Approved :9 <br /> l Fig. A. Location of proposed structures and ig <br /> /z8� existing structures, well, sewage sys- " S 0 <br /> `` jr <br /> tems, roads, etc., should be sketched = <br /> �d t in Fig. A. Include road setback, sideand back yard dimension and locationand setback from all bodies of water. <br /> 5 + If property is located at a highway in-tersection, show the intersecting high-ways and the setbacks required alongthem and at the intersection.PERMIT FEESSubdivision..... $25.00 + $2.00 per lot.Land Use................................. $10.00Build in ................................... 10.00........................... 20.0010.00 <br /> 10.00 <br /> Privy ....................................... 5.00 <br /> 01 <br /> ..... . ........ --.. ......7/ .i. /.�o.... ....� ... ....... <br /> Signature of O ner or Agent Date ZoningWdmr�i�Mnisrator <br /> Inspe on Date ... -. .. . . +J :�! .............................. <br /> />��..` .. ............... Inspector .. .. •::y7.F. /-.�:r}.:�..'...1.-...,./. <br /> Remarks /.1..- ..... �} .......,1N.2... .!7..s'1 .. al ........................................ <br /> ......................................................................................................................................................................6......................... <br /> ................................................................................................................................................................................6............... <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 />