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r <br /> Burnett County Office of Zoning Administrator f ) 00C _ o <br /> .__. <br /> CD 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 CD <br /> _ <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a " o <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, 77 , <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- -0CD 'Cl <br /> ° <br /> lations of the State of Wisconsin. d 32� <br /> �1 —• <br /> : d <br /> Owner or Agent (please print) * . Contractor or Surveyor <br /> � J A CD <br /> . . . . . . . . . . . . . . . <br /> Address ++ nn p Address a v <br /> jet P TF� �+ Ty W .S S' ��. 1 . . . . . . . . ('p/ {o 3 t a! :3 <br /> . . . . . . . . . . . . . . . . . . . . . . .x� 3To rD <br /> Phone Phone <br /> :L <br /> Plumber Well Driller t :T <br /> :a <br /> Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . CD o z <br /> CD 0 <br /> < <br /> o rt <br /> Phone Phone <br /> 0 - o <br /> m o <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: .� <br /> Type of Construction No. Bathrooms °� �z o <br /> 1. Work . . . . . . . . No. Bedrooms <br /> New Building . . .Lf Size . .3 ft. x . ft. Septic Tank Size Gals. <br /> Addition Height . . . . . Stories . . . . . . <br /> Sanitary Area 7a.Absorption Field Si e: <br /> Filling . . . . . . Soil Type . . . . . . ct ` c� 0 \ <br /> . . . . . . . . . . . . <br /> Moving . . . . . . 5. Permits Required Slope . . . . . . . . . . . . . . . . . . . . <br /> Grading . . . . . . Subdivision Perc. Rate :0` ''► <br /> Mobile Home Sanitary ( ,/ Dry Well CD CD <br /> Privy . . . . . . Building Seepage Trench . . . . . . CD fD <br /> Well . . . . . . Well Privy <br /> See p <br /> a e Bed �.Q�� o <br /> Subdivision . . . . . . Other (Specify) . . . . . . P 9 ;�. <br /> Conditional . . . . . . C iet cn cn <br /> C CD <br /> 2. Classification Land Use . . . . . . <br /> Zoning Dist. . . . . . . ; ° o <br /> 6. Use (describe exactly, 1 -fam. <br /> 3. Lot Size home, motel,etc.) FOR COMMERCIAL USE ''1 o <br /> :U = <br /> ft. x . . . . . . . . ft. Plans Submitted <br /> ` .�. . .. .... . sq. ft. Plans Approved . . . . . . <br /> ------------------------------------------Location ----------------- <br /> Fig. A. proposed structures and ' <br /> existing structures, well, sewage sys- h o <br /> tems, roads, etc., should be sketched = <br /> in Fig. A. Include road setback, side <br /> I <br /> )�Xay and back yard dimension and location c <br /> and setback from all bodies of water. <br /> If property is located at a highway in- <br /> *�� 3�, tersection, show the intersecting high- �C <br /> ways and the setbacks required along d <br /> �5 �/ them and at the intersection. <br /> J, PERMIT FEES <br /> 6 <br /> C�pn�r t Oultllt✓►0 �� ( ' Subdivision . . . . . . . . . $15.00 �� fD <br /> rr Land Use <br /> `C Building 5.0 <br /> Sanitary . . . . . . . . . . . 10.0 <br /> R cQ Well . . . . . . . . . . . 0 F <br /> Septic Tank . 0 <br /> 3 4 o i Combination Building, Sanitary <br /> and Well . . . . . . . 15.00 <br /> Privy . 5.00 <br /> ...................... .................................................... �........... ,�... . <br /> Sig ture of Owner or Agent Date ling A inistrator <br /> Inspection Date! 1....�.7........................ Inspector ..... .. .. it'�`:.. ��-... G <br /> : ...:............................... <br /> 1'. ... '' �� 'mil/.� -' T Remarks /..� C..................................... .. ..................................................... <br /> ................................................................................................................................................................................................ <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 />