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Icti- <br /> Burnett County Office of Zoning Administrator n\ ' <br /> CD CD m 0 o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT �. 3 * • <br /> 7 n -• <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 c <br /> work shall be done in accordance with the requirements of the County Zoning Ordinance, x a <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- — a) <br /> Ia./ <br /> ion of the State Wisconsin. Cl O <br /> , acre#- S /p _ o <br /> Owner or Age (please pri t) Contractor <br /> N <br /> K ; i we, t-e r a C <br /> Address Address 62 "� <br /> 11, <br /> .!.1? c\. Nt .k . <br /> Phone Phone <br /> Plumber <br /> Well Driller N., <br /> O \ <br /> Address Address 4 h o �l <br /> o ,-, <br /> DJ <br /> Phone Phone 0 h o <br /> CD o <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: -o <br /> Typffr Co structiAn No. Bathrooms c, z z o <br /> .3. o o <br /> 1. Work r No. Bedrooms `o ( /� <br /> New Building Size .7 . f". ft. Septic Tank Size Gajs. . v" <br /> Addition • <br /> f✓ Height l rQe� f� •7 0 ',--,.., <br /> Sanitary Area 7a.Absorption iel ife: m <br /> Filling Soil Type o <br /> Moving 5. Permits Required Slope <br /> Grading Subdivision Perc. Rate -n T <br /> Mobile Home Sanitary Dry Well - o <br /> Privy Building Seepage TrenchVI <br /> Well Well Privy `Seepage Bed L� �' <br /> Subdivision Other (Specify) oo cc) N <br /> Conditional 1c <br /> 2. Classification Land Use �*a <br /> I. <br /> Zoning Dist. o <br /> errn 11 i 12.0 6. Use (describe exactly, 1 fam. C o• 7 <br /> 3. ot�6ize 7`f 7 home, motel,etc.) ,. � FOR COMMERCIAL USE ( 7 <br /> /,ft. xQ ft. e77.� n a/ " Plans Submitted {� <br /> •, 0. e,r. . . I P ns Approved .. ��; ! <br /> . /ate (�fairce�1/2 _ 0� <br /> Fig. A. GQ7�Location of proposed structures and —I <br /> "—� r existing structures, well, sewage sys- IC . o <br /> Al//1"® tems, roads, etc., should be sketched 7 <br /> in Fig. A. Include road setback, side re, <br /> and back yard dimension and location <br /> and setback from all bodies of water. '-may y <br /> If property is located at a highway in- �,' <br /> _____,_, 4 <br /> tersection, show the intersecting high- ( . <br /> ways and the setbacks required along CY . <br /> them and at the intersection. <br /> v m <br /> i b PERMIT FEES 0, <br /> �' Subdivision $15.00 0Land Use 1 '-.•.. <br /> �` " Building 5.00 <br /> \ �5 Sanitary 10.00 :\ <br /> /`✓ Well 5.00 <br /> 0- Septic Tank N <br /> 10.00 <br /> lci j Combination Building, Sanitary <br /> A and Well 15.00 <br /> S—' <br /> Privy 5.00 <br /> 17 <br /> I B04i/$ ... k ... . ... (Ma( <br /> n r.�..•f._Owner or Age t __ Date Zo ing A inistrator <br /> y� Ai <br /> Inspe — --OLz CVO , _�� 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 />