Laserfiche WebLink
C'� <br /> Burnett County Office of Zoning Administrat � � -o � dtAPPLICATION FOR SANITARY — LAND USE ; iBUILDING PERMIT 3 0 � <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a -I o <br /> Permit for the work described and located as shown herein. The undersigned agrees that all nv H <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- -o a .tiV. <br /> lations of the State of Wisconsin. 3 a <br /> . . . e/1E4 . . . .f.iPktfr4- S'19-/77E- . 0 <br /> Owner or Agent (please print) Contractor or Surveyor H <br /> c <br /> . D9-,/6— G:c 'l a "V V <br /> Ad ress // Address a <br /> e7c6 t'S9 7 V 0 <br /> Phone --� \Phone ` <br /> 1 <br /> Plumber Well Driller 1 <br /> 1 <br /> Address Address o p, <br /> 2-cis- 35 11 <br /> , <br /> Phone Phone �CD ', r <br /> c) - o <br /> 0 ° r+ <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: -° <br /> Type of Construction No. Bathrooms 1. • • o z <br /> 1. Work . . . .ez,r.t �.Mefna. . . No. Bedrooms 3 ° A C <br /> New Building i• Size .V.4. ft. x . .16. ft. Septic Tank Size Gals. /.2,5'd <br /> Addition Height . .�. . Stories / C-eA/ , � t, ) 1 <br /> Sanitary K Area . . . . ./.?Vg 7a.Absorption Field Site: 6; CPID \ <br /> Filling Soil Type v`9@ 1 •V h <br /> Moving 5. Permits Required Slope / '..5. � v \4 <br /> Grading Subdivision Perc. Rate � ` <br /> Mobile Home Sanitary �'�' Dry WellCD CD�JtJ �~^� <br /> Privy Building , , ,)\• Seepage Trench (� CD r <br /> Well Well Privyta <br /> T T`\ �,N <br /> Subdivision Other (Specify) Seepage Bed te).0'0 o W <br /> Conditional r‘ t <br /> 1 cn..cn <br /> 2. Classification Land Use \ �'t� o-.__ <br /> Zoning Dist. <br /> 6. Use (describe exactly, fam. fi H• <br /> 3. Lot Size ome, motel,etc.) FOR COMMERCIAL USE ; `• <br /> ./' 42 . . ft. x . .-?•$Z'. ft. Plans Submitted <br /> sq. ft. Plans Approved �� <br /> 6 �� <br /> �c�tion of proposed structures and !� 6:AJ f-6C% existing structures, well, sewage sys- o <br /> tems, roads, etc., should be sketched <br /> it; in Fig. A. Include road setback, side = <br /> /2$0 ! and back yard dimension and location <br /> tag_, •2048 and setback from all bodies of water. ' <br /> If property is located at a highway in- b r) <br /> j v `' ��� tersection, show the intersecting high- % <br /> ways and the setbacks required along ' <br /> ityar wt_Zl..- them and at the intersection. '. X <br /> m Da <br /> 4$X3 Q PERMIT FEES <br /> vl to <br /> Subdivision $15.00 to fD <br /> Land Use 1.00 (7.. • <br /> I Building ,.41174 <br /> 5.00 q.\ <br /> Sanitary ' -}5.0: 11\ <br /> 5.0: <br /> 16' Well <br /> Septic Tank 10.s <br /> 0 Combination Building, Sanitary r1O <br /> and Well 15.00 <br /> &?'1i ke,40 u. Privy 5.00 <br /> .51 1 S, Ca,/ .A., 5 / - 79 �e%t <br /> Signature of Owner .r gent Date Zo I ministrator <br /> _ --' 1 <br /> 7 <br /> Inspection Date u 7 /,� / Inspector . .. .. . % —,-:" <br /> Remarks/i- �Fit- <br /> • <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 />