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i <br /> j / :q O <br /> Burnett County Office of Zoning Administrator -0 o -1 z <br /> ` PLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 r4 * • <br /> • <br /> TO T E ZONING ADMINISTRATOR: The undersigned hereby makes application for a _ o <br /> N <br /> Permit for the work described and located as shown herein. The undersigned agrees that all N � <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- o- ,� <br /> latio s of the State of Wisconsin. f, a <br /> O <br /> Owner o7 g hsent (please print N Contractor or Surveyor ti <br /> • <br /> Address Address <br /> w 1Sl ,... ......< <br /> co k <br /> o <br /> Sk r-r s r- -3 V i 8 6 �1 y <br /> Phone Phone o <br /> (4-1r.P4—c--%--- <br /> .‘ :k‘ss\'‘ <br /> Plumber Well Driller : Cr <br /> v <br /> Address Address m )0 • <br /> o , <br /> Phone Phone !ID,:l N <br /> 0 o :••••.., <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: - <br /> Type <br /> Construction No. Bathrooms o z ; <br /> 1. Work ( `�'"� No. Bedrooms ° <br /> co <br /> New Building L/ Size . ?. ft. x . . . �f.t. Septic Tank Size Gals. <br /> Addition Height Stories -7 S V ?� r <br /> Sanitary . . Area 7a.Absorption Field Site: `�j <br /> Filling Soil Type 't. o <br /> Moving 5. Permits Required Slope n <br /> Grading Subdivision Perc. Rate F 4.-1Mobile Home Sanitary ( / Dry Well CD 5, <br /> Privy / Building •• V Seepage Trench r t t t <br /> Well . .1,--.-!- Well • • C,_r..:..-- Privy <br /> Subdivision Other (Specify) Seepage Bed l 9X J t� <br /> Conditional (1? Cl) Cl) <br /> 2. Classification Land Use r <br /> Zoning Dist. Ap <br /> \ `�,z• ?' <br /> 6. Use (describe exactly % y. <br /> 3. Lot Size home, motel,etc.) FOR COMMERCIAL USE o <br /> ft x ft. Plans Submitted <br /> U v °--:?c .'. T. . . sq ft. Plans Approved �" '� <br /> - l 'I ; C <br /> Fig. A. r` <br /> A) Location of proposed structures and It 0 _i <br /> existing structures, well, sewage sys- " o <br /> tems, roads, etc., should be sketched , 0 <br /> 7 <br /> in Fig. A. Include road setback, side `per 3 <br /> and back yard dimension and location ", o- <br /> and setback from all bodies of water. <br /> If property is located at a highway in- - 1"1" /'� -,.ts <br /> t 1 ai 1,"' 6 tersection, show the intersecting high- ; `( i. <br /> L . v-3' ways and the setbacks required along 1 " <br /> them and at the intersection. /t' <br /> 3 "--, <br /> A xi <br /> \ ,---is- PERMIT FEES �` °' <br /> \5? Subdivision $25.00 + $2.00 per lot--\ -� m <br /> •18XaY Lan. Use $10.00 ' <br /> :uil:m• 10.00 - \ <br /> 44 <br /> 90 ` 4611, 10.00 ,--� <br /> £. tie-fink in n n S <br /> . C L.- Privy 5.00 `_ <br /> ' <br /> gnature o Owne A e t Date Zoning Administrator <br /> Inspecti Date <br /> . Q_r .7" .Qd. Inspector -2�e % ! L e <br /> Remarks � ca- c- os lz '� zi �.. r-L Q " . <br /> 8., <br /> ., i-P---r-f/-,---/--- zy-i-cr:',..,/,4 /._ei,r,,,Yezz ze4e,ego--/_-‘4( <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 he made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />