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Burnett County Office of Zoning Administrator 0 7 <br /> Cl) -o o --IC-- <br /> CD CD Cl, ° ° <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT -a <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 0., N <br /> work shall be done in accordance with the requirements of the County Zoning Ordinance, c V <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- o. <br /> latio s of the State of Wisconsin.At <br /> 3 co <br /> 1i. <br /> 0 er or Agent (please print) Contractor or-Straeyef-- yco <br /> fD <br /> 4-g oaeg .Z/i4.4;i7d,S07/1 RA/ <br /> a fl� <br /> Address g3. 413----"Address a ' <br /> Phone Phone 'V <br /> i4-?-7. A -)-7 <br /> Plumber <br /> Well Driller ( ,� <br /> A D ''17 •' ' V ;err C <br /> Address Address m T <br /> :c l, <br /> o� o <br /> Phone Phone CD <br /> 0 CD _ 0 :v l <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: -o �� <br /> ,-. <br /> Type of Construction No. Bathrooms • •C)• • z z a, v„ <br /> 1. Work No. Bedrooms 6 o ° <br /> New Building Size 2(p . ft. x .3.V. ft. Septic Tank Size Gals. . .0. . \ .< <br /> Addition Height ./. O.' Stories . . 1 \ <br /> Sanitary Area 7a.Absorption Field Site: r� <br /> Filling Soil Type *` o \ <br /> Moving 5. Permits Required Slope <br /> Grading Subdivision Perc. Rate : ,. <br /> Mobile Home Sanitary Dry Well co co <br /> Privy Building . ,i,� Seepage Trench �° �° �' :--A <br /> Well Well Privy <br /> Subdivision Other (Specify) Seepage Bed o <br /> Conditional Cl) N <br /> 2. Classification Land Use , ,. a n <br /> Zoning Dist. U',U� ° o' <br /> 6. Use (describe exactly, 1 -fam. d"',. �' <br /> 3. Lot Size home, motel, etc.) FOR COMMERCIAL USE i ° <br /> I��— . . ft. x ` ft. CL�- ,��/�' cS ! 0 ra .t Plans Submitted ` ,1. . . . . . .'} .6 ...4. . sq. ft. E Plans Approved • I(",�, <br /> Fig. A. Location of proposed structures and <br /> existing structures, well, sewage sys- o <br /> tems, roads, etc., should be sketched z <br /> C <br /> C6rrNe 7 <br /> in Fig. A. Include road setback, side = <br /> and back yard dimension and location v <br /> and setback from all bodies of water. <br /> y' If property is located at a highway in- <br /> Qf P tersection, show the intersecting high- <br /> , /y :-f ways and the setbacks required along cV <br /> Cct���Y a them and at the intersection. } <br /> /jpw. <br /> PERMIT FEES z <br /> j Subdivision $25.00 + $2.00 per lot. `D <br /> .7 ROac%a_� mb up <br /> * / Land Use $10.00 Y <br /> ,1- --, Building �10.00_, ; <br /> Sanitary ZU00 <br /> Da.K Well 10.00 <br /> Septic Tank 10.00 <br /> o jP^1 Privy 5.00 <br /> (Sort <br /> C U --)1 T��l r 0.(7 / /� / <br /> a , <br /> ignature of Owner or ge rr w� �" a .at rl <br /> Zoning , . , i�itor <br /> Inspection Date Inspector <br /> Remarks .. ..4. .4,,,ti, Y.57 <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 />