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BurnetWLI(CATION <br /> ty Office of Zoning Administrator y � 0 � Z <br /> FOR SANITARY — LAND USE — BUILDING PERMIT ~ 3 <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 y <br /> work shall be done in accordance with the requirements of the County Zoning Ordinance, zc <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- <br /> lations of the State of Wisconsin. o- p <br /> 3 d <br /> Owner or Agent (please print) Contractor or Surveyor H <br /> . . . . . . . . . . . . . n.6urs . LcJ�s •. . . . . . . . . . . a "4 �7 <br /> AddressQ�oom h9�>hz/}�/� S'S-V-2,0 A res, <br /> a <br /> g 6.io. -. 8�8. -. y3o y. . . . . . . . . . . . . . . ��� :-. .7.�a3 . . . . . . . . . . . . . . . . <br /> Phone Phone <br /> /00///�'� . . . . . . . . . . . . . . . . a <br /> Plumber Well Driller <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> Address Address o <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Ph. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> Phone one o <br /> o <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: <br /> Type of Construction No. Bathrooms o Z �° <br /> 1. Work . . . . . . . . . . . . . . . . . . . . No. Bedrooms ° <br /> New Building . . Size .02.5/. ft. x ..3 a2+ ft. Septic Tank Size Gals. <br /> Addition . . . . Height . . Stories /.Jo•s <br /> Sanitary X. . . Area 7a.Absorption Field Site: r- <br /> Filling Soil Typej. 1 ° <br /> Moving . . . . . . 5. Permits Required Slope • • • . . . • • • • • • • • . • . . • • <br /> Grading Subdivision Perc. Rate . . . . . . . . . . . . . . . . . <br /> Mobile Home . . . . . . Sanitary �!/ Dry Well ", ' <br /> Privy Building v Seepage Trench . . . . . . <br /> Well A . . Well .. Privy <br /> . . <br /> Subdivision . . . . . . Other (Specify) . . . . . . Seepage Bed IR.X.3�, � p <br /> Conditional . . . . . . I ;A c m <br /> 2. Classification Land Use . . . . . 0 <br /> Zoning Dist. ° <br /> 6. Use (describe exactly1 -fam. <br /> 3. Lot Size home, motel,etc.) FOR COMMERCIAL USE ° �� u <br /> /./.Q . ft. x �. . ft. Plans Submitted . . . . . . iW <br /> sq. ft. Plans Approved . . . . . . :•j� V <br /> ----------------- ------------------------------------------- <br /> Fi A. :o <br /> g. Location of proposed structures and <br /> existing structures, well, sewage sys- ;ry 0 <br /> tems, roads, etc., should be sketched <br /> in Fig. A. Include road setback, side s <br /> and back yard dimension and location <br /> and setback from all bodies of water. <br /> Va <br /> If property is located ata highway in- C�tersection, show the intersecting high-A1v� ways and the setbacks required alongVVIN <br /> them and at the intersection.PERMIT FEES S <br /> WS, Subdivision.....$25.00 + $2.00 per lot. m <br /> 1• Land Use................................. $10.00 <br /> Building................................... 10.00 <br /> I ,Ixit Sanitary .................................. 20.00 . <br /> Well ............................. 10.00 <br /> ^' Septic Tank ............................ 10.00 : <br /> Privy ....................................... 5.00 <br /> 9-� O <br /> �p <br /> Signatur f Ow r or Agent Date Zoning Admin is '� ` <br /> Inspection DateZ:)............ Inspector . _c"............................... <br /> G• - a� ' <br /> Remarks ..... 7..`.:G : ..r.....��....+ ._sf��/ !r.�. :... ::'. i.... c :G. 6, .4:. ::...:......... <br /> -L..................................................................................................................................... <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 />