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Burnett County Office of Zoning Administrator 4 <br /> E.o o CD CD CO � <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT ° 3 0 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a -1 0 - ., c `a <br /> Permit for the work described and located as shown herein. The undersigned agrees that all m y Ap <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- - °-a O /1 <br /> latio„ s of the State ofof Wisconsin. -' a ,►_.. ( 0 <br /> . J IA 7 co <br /> • J <br /> O NALA _ oo <br /> CD <br /> Owner or Agent (please print) Contractor or Surveyor H <br /> Q.,A 1-1,.._.. <br /> Address > Address a `4 0 <br /> .( c Citi — \113 �I <br /> Phone Phone -tom L <br /> 1 <br /> Plumber Well Driller t✓ <br /> 0 D <br /> Address Address ( G) <br /> o o <br /> o' �» <br /> Phone Phone G�r� 0 N r- <br /> 5 1aer�i��- sy <br /> CD o .4 <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: -o <br /> Type of Construction No. Bathrooms z z <br /> 1. Work ‘^'0o!� DC.c . No. Bedrooms o 0 o <br /> New Building \/ Size (5t-F`r. x4-l'°"") ft. Septic Tank Size Gals._ <br /> e d ition It. . Height Stories ex i ji- '7-5 ei <br /> Saran-ry Area 1S 0 i# -4 7a.Absorption Field Site: r- I`1\. <br /> Filling Soil Type V\ o <br /> e <br /> Moving 5. Permits Required Slope <br /> Grading Subdivision Perc. Rate <br /> Mobile Home Sanitary Dry Well CD m C.. <br /> Privy Building . , , , Seepage Trench 0 <br /> ER fft 0 IN <br /> Well Well Privy <br /> Subdivision Other (Specify) Seepage Bed . . .[�. o UA C <br /> Conditional 1 c <br /> 2. Classification a 7 Land Use <br /> Zoning Dist. �' a o' <br /> 6. Use (describe exactly, 1 -faro. tl �' <br /> 3. Lot Size home, motel,etc.) FOR COMMERCIAL USE 0 <br /> .1 .9.5. . . ft.x 11" 0 ft. ,q� o,,,, Plans Submitted O <br /> 10 �0 o l rsAM , �-t-� I L. <br /> sq. ft. 44 M Plans Approved s.) <br /> ZI��w 151,.,4*,0 Fig. A. Location of proposed structures and 0 -I <br /> existing structures, well, sewage sys- 9 0 <br /> terns, roads, etc., should be sketched F g <br /> in Fig. A. Include road setback, side <br /> AT Lays-j and back yard dimension and location -6' <br /> 7Sj �0+ Cy�Y and setback from all bodies of water. <br /> lifv 1 1 If property is located at a highway in- rr O <br /> tersection, show the intersecting high- <br /> 4- ways and the setbacks required along <br /> q)-t i <br /> i them and at the intersection. <br /> . fiIv PERMIT FEES a, <br /> 0.ISTI ,3..o' ,oA, Subdivision $15.00 0 <br /> `D <br /> SiEl�GI �,t Land Use p — <br /> 1-10 .� e Building5.00 c $ <br /> ,�,;�"' �'�EK'i Sanitary 10.00 <br /> Well 5.00 <br /> Septic Tank 1b00 O <br /> J Combination Building, Sanitary <br /> ?c4-0Qo G and Well 15.00 �, <br /> .„_,00Q�., " '+• Privy 5.00 0 <br /> d <br /> I4 (zit,ity i ih4 <br /> Signature of Owner or nt `A\D\O <br /> ate ping 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 />