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071Burnett County Office of Zoning Administrator <br /> iLr-)C <br /> • - •$ CD CD o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT -oCD <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 d y v` <br /> work shall be done in accordance with the requirements of the County Zoning Ordinance, 03 <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- v o_ <br /> lations of the State of Wisconsin. - a CA 0 <br /> Owner or ent (please print) Contractor or Surveyor N —mod `- <br /> j C L <br /> 1a t Reel-e AV, ' L. L d �� rn � �`4-I0 A 6, <br /> Address Address a <br /> .1 <br /> co <br /> 4' 11- 776 .. c1yy <br /> Phone Phone ' <br /> 4 <br /> Plur er Well Driller 3\. i <br /> •.3) .Q• <br /> Address Address 1 ; C) --.1 <br /> < ,s <br /> o. -.7 4 <br /> Phone Phone H <br /> ( o '-' <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: • ° <br /> Type,of Construction No. Bathrooms l o Z oa \ <br /> 1. Work 4--r v w.� t- No. Bedrooms ° m <br /> New Building --�'`' Size *. . . , ft. x .5.'. . ft. Septic Tank Size Gals. <br /> Addition Height Stories i.�. .L rn <br /> Sanitary Area 7a.Absorption Field Site: 0m <br /> Filling Soil Type . . ,5.4 '1 7 0 <br /> Moving 5. Permits Required Slope • <br /> Grading Subdivision Perc. Rate 4., <br /> Mobile Home Sanitary ✓ Dry Well 1 m VI <br /> Privy � �• Building ‹. Seepage Trench CD " � <br /> .I,'<' . <br /> Well . Well •`,/ Privy PI <br /> Subdivision Other (Specify) Seepage Bed I cr.,).,6 7 N <br /> Conditional Cl) m <br /> 2. Classification R--2„.. Land Use I 6 h <br /> Zoning Dist. 1 ! o <br /> 6. Use (describe exactly, 1 -fam. _' <br /> 3. Lot Size home, motel,etc.) FOR COMMERCIAL USE o <br /> I GC ft. x 40v ft. Plans Submitted �, 7 <br /> sq. ft. Plans Approved �,1 (. : <br /> 1 <br /> Fig. A. • Location of proposed structures and 4 ( _1 <br /> existing structures, well, sewage sys- LP o <br /> • tems, roads, etc., should be sketched P <br /> in Fig. A. Include road setback, side <br /> (::.. <br /> e�•ti^ and back yard dimension and location G, a <br /> and setback from all bodies of water. _rr <br /> 1,,,, and <br /> If property is located at a highway in- i <br /> �c; } �1 tersection, show the intersecting high- <br /> h4S 101 ways and the setbacks required along rf\ • <br /> Zc 4ll them and at the intersection. 1 <br /> , Do <br /> i i PERMIT FEES <br /> ...A.. Subdivision $15.00 <br /> an <br /> co <br /> / Land Use 1.00 <br /> ;'t Building 5.00 <br /> • Sanitary 10.00 _ ) <br /> Well !: f <br /> /' Septic Tank P.00 <br /> /Ly Combination Building, Sanitary <br /> and Well 15.00 , ' <br /> 0.1 <br /> :Agent <br /> Privy . 0 ,1. <br /> ,. '1 <br /> -'Signs re of/�w)n�ero /a �/ Date Zo ng A�r inistrator <br /> Inspection Date `—� `�� ` .. . r .T..7Q.. Inspector <br /> Remarks <br /> (;) t ' Cerp1-4.. .../ <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 />