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i <br /> Burnett County Office of Zoning Administrator cn o - E._, <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT ° 3 F <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a —I . o '.A <br /> Permit for the work described and located as shown herein. The undersigned agrees that all H <br /> work shall be done in accordance with the requirements of the County Zoning Ordinance, cp , <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- -a eNA_ V! <br /> lations of the State of Wisconsin. co c I p <br /> STD .J. . . .T. #� co <br /> Owner or Agent (please print) Contractor or Surveyor H ` <br /> c <br /> 2135 P/ //ti&b GO aCill <br /> Address Address a y <br /> m <br /> Phone Phone <br /> L,E - PeoFriT S005 1I `1. tTl <br /> Plumber Well Driller tV <br /> ` A i�-1 Cf4-M� �l �:V/ o <br /> Address Address C <br /> o o <br /> Phone Phone CD H r Z <br /> n ^. o <br /> CD o '* <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: -° <br /> Type of Construction No. Bathrooms I z z 0 0 °° <br /> 1. Work W007) PIZ ' No. Bedrooms . . .v1 CD <br /> o <br /> New Building X Size . Z,12. ft. x . .4.o. ft. Septic Tank Size Gals. . . 760 �� <br /> Addition Height Stories "^l <br /> Sanitary . . X. . Area 7a.Absorption Field Site: r 1vi <br /> Filling Soil Type SAA--D o <br /> —e o <br /> Moving 5. Permits Required Slope p' <br /> 4` <br /> Grading Subdivision Perc. Rate a . . . <br /> • <br /> Mobile Home Sanitary • Dry Well CDm CD <br /> m <br /> Privy Building , , Seepage Trench CD CD 2 (►` <br /> ta VI <br /> Well . .)4 . Well K PrivyZ. <br /> Subdivision Other (Specify) Seepage Bed f8.p5 o <br /> Conditional 'N m N <br /> c <br /> 2. Classification / �r Land Use 1 a r) <br /> • <br /> Zoning Dist. ,I (� Z' g <br /> 6. Use (describe exactly, 1 -fam. y' <br /> 3. Lot Size homelmotel,etc.) FOR COMMERCIAL USE ° <br /> ft. x ft. Plans Submitted <br /> 40 A- sq ft. Plans Approved <br /> (1.ci k--- <br /> . <br /> Fig. A. Location of proposed structures and <br /> existing structures, well, sewage sys- V\ (Y o <br /> tems, roads, etc., should be sketched <br /> in Fig. A. Include road setback, side = <br /> and back yard dimension and location h• - <br /> and setback from all bodies of water. 0 <br /> If property is located at a highway in- <br /> tersection, show the intersecting high- 4 <br /> Iw ways and the setbacks required along <br /> them and at the intersection. S-- <br /> ?SO ,YEla a N „ <br /> 2410 t6 PERMIT FEES I a' <br /> 2' ,J /N Subdivision $15.00 1� TO <br /> /1/2-3 Land Use 1.00 <br /> Building •• �/ <br /> eI\ a • Sanitary ormw i <br /> .10 <br /> O Well —wo040 :4 <br /> I Septic Tank 11 <br /> �/ Combination Building, Sanitary <br /> Slilt56 74416 and Well 15.00 <br /> Privy 5.00 <br /> 7 7—" 7, i , nja66,16( <br /> ature o Owne or ge Date onin dministrator <br /> Inspection Date ..L' O /` 4 Inspector ./ . .... . , <br /> Remarks .��/..1.. / <br /> `, CiCr?` ` 77� L.. L://-— <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 />