Laserfiche WebLink
1 <br /> Burnett County Office of Zoning Administrator <br /> -FLICATION FOR SANITARY — LAND USE — BUILDING PERMIT _• <br /> ° °7 <br /> 0 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a '* <br /> Permit for the work described and located as shown herein. The undersigned agrees that all N N o <br /> work shall be done in accordance with the requirements of the County Zoning Ordinance, ���111 <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- •o °- \� _"°' <br /> laticns of the State of Wisc nsin. C <br /> ThVQ,. f c f/ H. \ "4". .."Owner or Agent (please print) Contractor or Surveyor ` (-1 m <br /> S 4 © �vr c ), Av C1:1' ; i -' <br /> Address Address r' a <br /> 8t^,.f. f"/yn C L t t r (/)- f� ' 3' ti " 3 D. 9 s r <br /> -Acl <br /> Phone Phone <br /> 4470ILL. <br /> u� �1C <br /> Plu ber i <br /> Well Driller � <br /> T <br /> CD <br /> Address Address �' O <br /> !\ .0 ° <br /> Phone Phone <br /> %M o ,' <br /> H r <br /> m ., o <br /> DESCRIPTION 4. Building Details 0 <br /> 7. Sanitary Facilities: i a v <br /> Type of Constyaction No. Bathrooms z (7)1. Work -A.. > ( S f r '7 S No. Bedrooms `- o o o <br /> CD <br /> New Building Size ft. x O` ft. Septic Tank Size Gals. !A z.:- Z <br /> Addition Height Stories <br /> Sanitary .`/ Area 7a.Absorption Field Site: \• E.o <br /> Filling Soil Type �, 1— <br /> Moving 5. Permits Required Slope W <br /> Grading Subdivision Perc. Rate <br /> Mobile Home Sanitary C./ Dry Well F <br /> Privy '� E <br /> Building Seepage Trench <br /> Well Well Privy <br /> Subdivision Other (Specify) Seepage Bed <br /> Conditional j//C ij/7 <br /> 2. Classification Land Use �� C .. <br /> Zoning Dist. w a <br /> o• <br /> 6. Use (describe exac y, 1 -fam ° <br /> 3. Lot Size home, motel,etc.) FOR COMMERCIAL USE AO a. <br /> ft. x ft. ° <br /> Plans Submitted <br /> . . - .Ci . S. t. . sq. ft. Plans Approved <br /> Fig. A. Location of proposed structures and <br /> existing structures, well, sewage sys- ,v / o <br /> tems, roads, etc., should be sketched a.. a <br /> in Fig. A. Include road setback, side ^ 3 <br /> and back yard dimension and location \ -a' <br /> 0and setback from all bodies of water. . <br /> If property is located at a highway in- <br /> tersection, show the intersecting high- `� ' <br /> �(, /1 ways and the setbacks required along � <br /> ?► <br /> \\,. I f A-A) (1 them and at the intersection. <br /> JO <br /> r <br /> PERMIT FEESco <br /> Subdivision $25.00 + $2.00 per lot. Co <br /> Land Use $10.00 <br /> Bui <br /> 10.00 CC <br /> anitary .. & 20.00 <br /> ill <br /> Well 10.00 <br /> Septic Tank 10.00 <br /> Privy 5.00 <br /> ad4, <br /> ,9, <br /> ‘167 <br /> 4.2 <br /> ignatur of Owner or Agent ,/,,,,,i, <br /> Zoning Administrator <br /> Ins ection Date ^ e. / <br /> p / �/ p Inspector ...,r !t-iee' re7 ':4 1.,� <br /> Remarks .(.,:' ..,.f.,4 C--C'..2.;--4-'i r <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 />