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Burnett County Office of Zoning Administrator o Z <br /> 061PLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 o <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 C` <br /> work shall be done in accordance with the requirements of the County Zoning Ordinance, 4w <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- -0 a w <br /> lations of the State of Wisconsin. 3 \ S- <br /> / _. <br /> . . . . . . . . . . . . . . . . . . � � .� . . . . . . . Ce..r. . <br /> o <br /> Owner or Agent (please print) Contractor orrveyor <br /> N Y' <br /> Add/ . . . . �.�. .� . . ��. .��.��. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . a o <br /> rkP Address a <br /> �.fi. f w-� 6� �. �.s s v �f 3. - <br /> Phone Phone <br /> Plurriber Well Driller <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A <br /> Address ddress 0 <br /> � o 1-1 <br /> o <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> Phone Phone y 0 <br /> � o <br /> 0 <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: 1 ° <br /> Type of Construction No. Bathrooms o Z �0 <br /> 1. Work .lC,.V, Vv%.. . . . . . . <br /> . . . <br /> ft. x .01.k. ft. Septic Tank Size Gals. <br /> Addition Height . . . . . Stories . . . . . . G . <br /> Sanitary �� Area . . . . . . . . . . . . . . . . . . . 7a.Absorption Field Site: <br /> Filling . . . . . . Soil Type p o <br /> e <br /> Moving . . . . . . 5. Permits Required Slope • • • • . • • • . • • • • . . . . . • • S <br /> Grading . . . . . . Subdivision . • . . . . Perc. Rate . . . . . . . . . . . . . . . . . s <br /> Mobile Home Sanitary (r/ Dry Well T M :S <br /> Privy / Building Seepage Trench . . . . . . <br /> Well v Well Privy <br /> Subdivision . . . Other (Specify) . . . . . . Seepage Bed <br /> Conditional ) N <br /> .Ai Q n <br /> 2. Classification Land Use . . . . . . o <br /> Zoning Dist. <br /> 6. Use (describe exact) 1 -fam. _N <br /> 3. Lot Size home, motel,etc.) FOR COMMERCIAL USE o <br /> ft.x . . . ft. Plans Submitted . . . . . . <br /> V.�. .17 sq.ft. Plans Approved <br /> ---------------------------------------- -----9-------------9—Y- y <br /> Fig. A. ` Location of proposed structures and <br /> a �{ 0 <br /> existing structures, well, sewage s s- � o <br /> �� tems, roads, etc., should be sketched <br /> �IT 'C y in Fig. A. Include road setback, side T <br /> and back yard dimension and location <br /> and setback from all bodies of water. <br /> If property is located at a highway in- <br /> tersection, show the intersecting high- (Z)"j 7l <br /> ways and the setbacks required along <br /> q// r them and at the intersection. <br /> PERMIT FEES <br /> Subdivision.....$25.00 + $2.00 per lot. :� D <br /> Land Use................................. $10.00 <br /> qO, uild � .... 1 :� <br /> ................ ... ... <br /> � anita ................... .. .. ....... <br /> J - u ........................................ 10.00 <br /> J - k ............................ 4S@0 <br /> Privy ....................................... 5.00 <br /> :.... .. ..�o....... .... .. ..:. >�. . ... .... <br /> Signature Ow or Agent ate / Zoning Administrator <br /> InspectionDate ................................................ Inspector ................................................................................................ <br /> Remarks ............................................................................................................................................................ <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 />