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)(rbtfil <br /> , � � <br /> Burnett County Office of Zoning Administrator _c b H z <br /> 4:PLICATION FOR SANITARY — LAND USE — BUILDING PERMIT . 3 <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 �� <br /> work shall be done in accordance with the requirements of the County Zoning Ordinance, CD �, <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- m ° <br /> lations of the State of Wisconsin. 0 �„ ^ p <br /> S+'vcI .J4J.,d J - tug 1 k 1 'Pkm0I� — e1 <br /> Owner or Agent (please print) Contractor or Surveyor y at. -� <br /> (� c n 4" <br /> t. ( v. btlry fSC- , o c <br /> Address Address a <br /> Phon Phone 4..,, <br /> 4-0 <br /> R <br /> Plumber Well Driller ` <br /> E. <br /> N..:\jor.:%6 <br /> CDF <br /> Address Address CD o <br /> C �' <br /> < 3.o <br /> Phone Phone H or <br /> o gly <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: la ° <br /> Type of Construction No. Bathrooms��S Z z °o <br /> 1. Work —Q.Xi' ` ') No. Bedrooms ° CD \p <br /> New Building Size ft. x ft. Septic Tank Size Gals. `\ .< 4 <br /> Addition Height Stories �,�` <br /> Sanitary . . l.� Area 7a.Absorption Field Site: `, r Th <br /> Filling Soil Type `4` o <br /> Moving 5. Permits Required Slope <br /> Grading Subdivision Perc. Rate \;, <br /> Mobile Home Sanitary t..-- Dry Well CD �• <br /> Privy Building Seepage Trench fD r- <br /> Well Well Privy m y, "' <br /> Subdivision Other (Specify) Seepage Bed 13, 3,k. ;\ <br /> Conditional I c CD <br /> 2. Classification Land Use�:O „I a <br /> Zoning Dist. \ ° <br /> 6. Use (describe exact) 1 -fam. <br /> 3. Lot Size home, motel,etc.) FOR COMMERCIAL USE ° <br /> fit_x ft. Plans Submitted <br /> �l(/ . sq ft. Plans Approved f �� <br /> Fig. A. Location of proposed structures and '-.I %J <br /> existing structures, well, sewage sys- i 0 <br /> +�, � tems, roads, etc., should be sketched ° <br /> i <br /> tt in Fig. A. Include road setback, side —3 <br /> and back yard dimension and location -o <br /> and setback from all bodies of water. <br /> If property is located at a highway in <br /> f . <br /> In 14 i tersection, show the intersecting high- <br /> ways and the setbacks required along <br /> .t. IJv1 hPl�h, r <br /> them and at the intersection. •n <br /> • <br /> v PERMIT FEES <br /> Subdivision $25.00 + $2.00 per lot. <br /> Land Use $10.00 <br /> 10.00 <br /> f v�,.7— 25vo0 — 1 <br /> 10.00 <br /> Septic Tank 10.00 <br /> Privy 5.00 <br /> ignat.re ;f Owner or Agent D e Zo ing dministrator <br /> Inspection Date Inspector <br /> Remarks <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 />