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Burnett County Office of Zoning Administrator C7�wy J/ <br /> 0 0 z <br /> APPLICATION FOR SANITARY — 'LAND USE ` BUILDING PERMIT <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 /> work shall be done in accordance with the requirements of the County Zoning Ordinance, x ` :' ,J ` <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- v 0 " 1 V <br /> a I <br /> lations of the State of Wisconsin. <br /> �, ore !� . . . .�1en�e.L �. . � �. . J � <br /> 3 d <br /> Owner or Agent (,p/lease print) Contractor or Surveyor <br /> Lin <br /> csc � . <br /> . . ... . . ..y ... . .Address Address a <br /> h <br /> n <br /> Phone <br /> Phone <br /> J..../vf1r. . . <br /> Plumber � ��� Well Driller . . . . . . . . . . . . . . . . . . � � � � ' . . . ' <br /> f . . . . . . . . . . . . . . . <br /> Address . . . _ <br /> ' " " <br /> Address " <br /> n p :G <br /> . . . . . . - <br /> Phone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . „V �( <br /> 11\nl � ` 1 N <br /> Phone o <br /> N <br /> n o <br /> o <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: � a v <br /> Type f CoT struction No. Bathrooms z z o <br /> 1. Work No. Bedrooms <br /> New Building . .4__,! Size C4 ft. x ft. <br /> Height . . . . . Stories Septic Tank Size Gals. f('h <br /> Addition <br /> . . . . . . . . . . . . <br /> Sanitary Area 7a.Absorption Field ite: <br /> Filling . . . . . . Soil TYPe a s? '6 i(� is ^ :rn r �,I <br /> 0 <br /> Moving . . . . . . 5. Permits Required Slope �J <br /> Gradin <br /> 9 . . . . . . Subdivision Pere. Rate . t <br /> Mobile Home Sanitary (�� Dry Well - - m r <br /> Privy Building C/ Seepage Trench y 2 . . . , m i'-} <br /> Well . Well ✓ Privy <br /> Subdivision . . . . . . Other (Specify) . . . . , . Seepage Bed $z1 a o� <br /> Conditional �J :V 1 -! Mitt) <br /> 2. Classification ,yR.-.� Land Use 11 N <br /> Zoning Dist. � ) -�--- � 0 <br /> .?tea <br /> < <br /> 6. Use (describe exactly, 7� 0 <br /> 3. Lot Size v'` n home, motel, etc.) FOR COMMERCIAL USE <br /> 7. y <br /> o F <br /> ,.8. . . . ft. x . q�. ft. Plans Submitted , , . . . ' 'Q> <br /> sq. ft. Plans Approved <br />---------- ----------- p <br /> --- ------------------ .� . <br /> L0.I��� Location of proposed structures and --`, <br /> ��- existing structures, well, sys- i4 o <br /> V, <br /> tems, roads, etc., should b2�1C€ ,' _,d <br /> V <br /> ��Nt�m n Fig. A. Include road setback, side <br /> #7 and back yard dimension and location <br /> and setback from all bodies of water. " 1C <br /> n If property is located at a highway in- :'r-':, !, <br /> Itersection, show the intersecting high- � _ <br /> ways and the setbacks required along --� <br /> them and at the intersection. <br /> �f 7 PERMIT FEES <br /> jj <br /> Subdivision . . . $15.00 `0 <br /> Land Use . . <br /> 1.00 I' <br /> ry� /(`Building . . . . . . . . . . . 5.00 <br /> 1 p f Sanitary . . . . . . . . . . . 10.00 <br /> 1 Well 5 fi <br /> 1MrSeptic Tank . . . . . . . . . U.00 :` <br /> l Combination Building, Sanitary <br /> and Well 15.00 <br /> /Privy <br /> y./. �J 0 <br /> ...... . / F/_� .'�3 ... .. <br /> Signatof O er or Age ate ' <br /> Zo � i trator <br /> Inspection Date(„11.1 ,. � . .. .. <br /> ( � Ca... ...l�cfl. / Inspector <br /> / G . n.?-'.':i` i. ......... . . .... . ........ <br /> Remarks ... :. <br /> ..........................................................................................I.............. <br /> . -.... ........... .. .. <br /> ... ..... .... ......\/)... . ............................I................... <br /> NOTE: A preliminary site inspection must be mad and site a proval ranted on all structures involvingsanitaryfacilities <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 />