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Burnett County Office of Zoning Administrator in 0 H z <br /> CD CD CO 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT ° 3 r+ <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a -I = o `C <br /> Permit for the work described and located as shown herein. The undersigned agrees that all 0., y <br /> work shall be done in accordance with the requirements of the County Zoning Ordinance, (`) <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- ° <br /> CD ---' lk .se.' <br /> lations of/the <br /> tate .f Wisconsin. 0 <br /> Owner or Agent (please print) Contractor or Surveyor H <br /> 6,4)7-7,/c2 4fr„,:j. 71..„....644 cO ')` ' 'N . ›*. t <br /> ft <br /> Address Address a r :'� <br /> co <br /> CD <br /> Phone Phone ` <br /> Plumber Well Driller <br /> Address Address co o <br /> ,� rt `• <br /> Phone Phone MI ,� <br /> m c r <br /> . c> .. 0 <br /> 41 m 0 <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: -0 <br /> Type of Construction No. Bathrooms ;: o z �° 9.) <br /> 1. Work ,:/' ;.� No. Bedrooms ° CD <br /> New Building Size 4,(,. ft. x .34 . ft Septic Tank Size Gals. \ .Z <br /> Addition Height . Stories /r <br /> Sanitary Area 7a.Absorption Field Site: r <br /> Filling Soil Type o <br /> Moving 5. Permits Required Slope <br /> Grading Subdivision Perc. Rate <br /> Mobile Home Sanitary Dry Well :CD m { <br /> Privy Building Seepage Trench CD CD <br /> Well Well Privy Sfl <br /> Subdivision Other (Specify) Seepage Bed O . p, n� <br /> Conditional o \� NI ' �\. 'Cl) <br /> 2. Classification Land Use 8 Zoning Dist. -'� C,' Z' 0 <br /> n J 6. Use (describe exactly, 1 -fam. ,, y: ., , <br /> 3. Lot Size •4 '‘''il home, motel,etc.) FOR COMMERCIAL USE No. ° <br /> 36` ft. x .- 7/ ft. Plans Submitted k-dC <br /> sq. ft. Plans Approved <br /> ra. <br /> Fig. A. Location of proposed structures and <br /> existing structures, well, sewage sys- 'o <br /> tems, roads, etc., should be sketched 0 <br /> Iin Fig. A. Include road setback, side - <br /> 11 and back yard dimension and location 4 <br /> t + and setback from all bodies of water. *. -.T <br /> C A 8f If property is located at a highway in- 'h <br /> tersection, show the intersecting high- <br /> ways and the setbacks required along p, . S <br /> r�� j•• �d( them and at the intersection. . <br /> . , PERMIT FEES 2 <br /> -�- .." Cc <br /> . Subdivision $25.00 + $2.00 per lot. <br /> . <br /> k(/ <br /> Land Use $10.00 t; <br /> ----i <br /> ( :uilding 3 .00 ''i,, $ <br /> C�t ,rp anitary 5.00 ; ' <br /> X/ �6jx , A4 Well 10.00 tk <br /> Privy 5.00 iN <br /> e, d° <br /> .ge,t),...e2/ (de. oe 0-e4.-- if--- Q7 -,e, /./S'el.eJia6,1) <br /> Signature of Owner or Agent Date Zoning Administrator <br /> Inspection Date �Ins�Lpector,�Q <br /> Remarks .. ,4 '.�"� ;;74. ,✓" <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 /> 4!. <br />