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aloyrte .________ <br /> Burnett County Office of Zoning Administrator , o H z <br /> J cp d o 0 <br /> LICATION FOR SANITARY — LAND USE — BUILDING PERMIT `` E AI N'I� <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes a ,COMP PT _ o <br /> Permit for the work described and located as shown herein. The undersigned agrees that all fi <br /> work shall be done in accordance with the requirements of the County Zoning Ordinance, cp q. <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- v ° �` <br /> lations of the State of Wisconsin. , v Ns rr'/ �c.q .v.I. abLA) `f l S .cP eG c cc' (z C A S% ' -» <br /> Owner or Agent (please print) ,Contractor or urveyor y `"° <br /> r C� ° n <br /> /� <br /> t� O 0 9 I-* \1 i 9 J� Tt r Q 0 7 <br /> Addr ss Address <br /> R fi f w-, 63 r— u;.t S C U ff• CD <br /> Phone Phone <br /> p ....j.4TIL., <br /> Plui)ber Well Driller <br /> 11 <br /> Address Address �' <br /> " o 1,1 <br /> h < <br /> o - in <br /> Phone Phone co N i— <br /> n ,� 0 <br /> CD o .« <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: f ° <br /> Type of Construction No. Bathrooms +�1 z Z ° <br /> 1. Work / / v." No. Bedrooms .tom_ o CD <br /> L../ �/ <br /> New Building Size .a. �• ft. x .Gt.k. ft. Septic Tank Size Gals. <br /> Addition Height Stories .'2 C � Tv, <br /> Sanitary v-- Area 7a.Absorption Field Site: ‘•y <br /> Filling Soil Type V p" o <br /> e <br /> Moving 5. Permits Required Slope <br /> Grading Subdivision Perc. Rate I <br /> Mobile Home Sanitary C.. Dry Well I CD S <br /> Privy / Building Cam— Seepage Trench co <br /> (;) <br /> Well L/ Well . . �,�. Privy p .. <br /> Subdivision Other (Specify) Seepage Bed (.O./. <br /> Conditional '' (CI cn <br /> 2. Classification Land Use A <br /> Zoning Dist. ° o' <br /> 6. Use (describe exactl 1 -fa m. ° <br /> 3. Lot Size home, motel, etc.) FOR COMMERCIAL USE O. <br /> c <br /> +� <br /> ft x ft. Plans Submitted "�' <br /> a0J v 0 c 1- sq ft. Plans •Approved •. <br /> Fig. A. I r� Location of proposed structures and —I4'l existing structures, well, sewage sys o <br /> �` <br /> . h�S�, tems, roads, etc., should be sketched <br /> in Fig. A. Include road setback, sideGI S- <br /> and back yard dimension and location _t o <br /> and setback from all bodies of water. <br /> If property is located at a highway in- ,�1N 7 <br /> SC'S <br /> � <br /> tersection, show the intersecting high- Qjt O <br /> ways and the setbacks required along / <br /> ., <br /> c them and at the intersection. ?� <br /> j PERMIT FEES <br /> a� Subdivision $25.00 + $2.00 per lot. co <br /> Land Use $10.00 <br /> co <br /> oc <br /> 40r A:uild'.• • 10 00 M <br /> giViNFIP <br /> 10.00 <br /> 0 I . 'S,, .. T 1 k 40 q. <br /> Privy 5.00 <br /> 1 <br /> l O <br /> P <br /> aDI e � . / �L. <br /> Otc <br /> %' <br /> s. ..:.Signature Ow or Agent / Zoning Administrator <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 he made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />