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00-YV --i <br /> Burnett County Office of Zoning Administrator y UN _- <br /> APPLICATION FOR SANITARY — LAND li$E' BUILDING PERMIT �. 3 <br /> C <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a CD <br /> H - o <br /> Permit 'Tor the work described and located as shown herein. The undersigned agrees that all oo y t <br /> work shall be done in accordance with the requirement __gun y Ordinance, CD i <br /> Sanitation Code, and with all other applica �• ty Ordinances and the law nd regu- ° /) ( " <br /> lations of the State �offeWisconsin <br /> � J �'^ <br /> ,- ,,, <br /> _ _ ..i - <br /> 6acip AwL6. .Rd.,. . . . . . . . ,.., <br /> Owner or Agent (please print) Contractor or Surveyor CD <br /> 7(Z 4 /4/CoLN ,Jlad�} CD <br /> Address SI- "PAU L. i r)1 Iv S_5IO c Address a (-N <br /> Phone Phone <br /> Plumber Well Driller ' <br /> W E sr-erz-1 Li'i S \ 0 <br /> Address Address ( o kA <br /> p 6^—VODr <br /> Phone Phone ''‘Q. = p <br /> co o <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: -o <br /> Type of Construction No. Bathrooms (• o z oa <br /> 1. Work No. Bedrooms 3• • • ° co 0^1 <br /> New Building Size ft. x ft. Septic Tank Size Gals. 1000 <br /> Addition Height Stories -; \ : <br /> Sanitary . ,1(. - - Area 7a.Absorption FAId Sitt t e: r <br /> Filling 0 <br /> Soil Type -7, A~ /r� <br /> 14 <br /> Moving 5. Permits RequiredSlope 4 �-`\ 4 <br /> Grading Subdivision Perc. Rate 3— 4f--S � Cf <br /> Mobile Home Sanitary Dry Well CD C <br /> Privy Building Seepage Trench SA <br /> Well Well Privy ' Evr, <br /> C <br /> Subdivision Other (Specify) Seepage Bed o N N <br /> Conditional <br /> 2. Classification J� _ Land Use li Cy c co <br /> a rt_ <br /> Zoning Dist. / t -. o <br /> 6. Use (describe exact) _. <br /> C <br /> 3. Lot Size home, motel,etc.) FOR COMMERCIAL USE o <br /> C - , <br /> *xe:CS . , ft. (IvPlans Submitted ,sq. . <br /> ft. Plans Approved <br /> Nv Fig. A. Location of proposed structures and -I <br /> 1 N KC. existing structures, well, sewage sys- o <br /> � L tems, roads, etc., should be sketched a o <br /> in Fig. A. Include road setback, side UJ <br /> ---- — and back yard dimension and location .9) -o <br /> and setback from all bodies of water. i c.i <br /> PAI eg / If property is located at a highway in- f , <br /> fr esQ tersection, show the intersecting high- �l�` <br /> fTr ways and the setbacks required along (n <br /> o P$131N WELL them and at the intersection. <br /> � �'7 <br /> �� <br /> `0 PERMIT FEEguargur , <br /> : co <br /> YQs s \v �� c0° Subdivision $15.00 fD <br /> o P Land Use 1.00 1 <br /> '3$ < Building 5 00 <br /> SI: Sanitarycs..11:0.9)) 0. i <br /> 1111 Well 5.00 <br /> lf° 01/4/tI'; Septic Tank 10.00 <br /> Combination Building, Sanitary <br /> and Well 15.00 <br /> Privy 5.00 <br /> &/,,,,k77X. , 2/z/h - <br /> Signature of Owner or Agent afe on mg. dministrator <br /> x'Inspection Date 9 T U Inspector a-'1-47 6... D <br /> Remarks <br /> oA.- <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 />