Laserfiche WebLink
uA \ C <br /> Burnett County r Office of Zoning Administrator o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMITCD <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 a) " ~' <br /> work shall be done in accordance with the requirements of the County Zoning Ordinance, x- CD <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- -v o- <br /> lations of the Stat of Wisconsin. CDa NI <br /> h N. <br /> Owner or Agent (please print) Contractor or Surveyor N V, <br /> -4.7-/( /03 LgAve' it : mp45 u. a <br /> Address Address <br /> a T <br /> m 0 <br /> Phone Phone CD <br /> V <br /> 1 <br /> Plumber Well Driller <br /> Address /� Address A m �' <br /> N o 0 <br /> 7-�-L{ 3 5 ( . E ` <br /> Phone Phone ` CDO r- <br /> m 0 •* <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: -o <br /> Type of Construction No. Bathrooms o z <br /> 1. Work . . . L.veP.rR/f 2ff No. Bedrooms ° <br /> New Building X. Size �� ft. x . . ft. Septic Tank Size Gals. .994., L <br /> Addition Height .3. . Stories . I. . .S.7°CE 'V <br /> Sanitary . . X . Area /p 7a.Absorption Field Site: <br /> Filling Soil Type . . Sr9/`1> O 0 <br /> sIzzt <br /> Moving 5. Permits Required Slope /5."�® W � h <br /> Grading Subdivision Perc. Rate �� \T� <br /> Mobile Home Sanitary ar` Dry Well CD CD <br /> Privy Building . .x. . Seepage Trench -yam,co co <br /> Well Well . .'K.. . Privy Z <<9.?, � ^\ <br /> Subdivision Other (Specify) Seepage Bed /S. 3 J-_�'io <br /> t 3 <br /> Conditional V1 c c <br /> 2. Classification Ai) Land Use \ k FL <br /> ' <br /> Zoning Dist. a ? <br /> 1 -fa 6. Use (describe exactly, m. a \ H' <br /> 3. Lot Size home motel,etc.) FOR COMMERCIAL USE CT <br /> o <br /> ./64). . . . ft. x -2-2-C) ft. Plans Submitted r`. <br /> sq. ft. Plans Approved r_ <br /> Fig. A. Location of proposed structures and <br /> r existing structures, well, sewage sys- ,Q'y, .Z o <br /> i� tems, roads, etc., should be sketched <br /> /tY in Fig. A. Include road setback, side / s <br /> <'' and back yard dimension and location -o. <br /> and setback from all bodies of water. N <br /> i If property is located at a highway in- <br /> r �,,,a� tersection, show the intersecting high- y (' <br /> % "t, <br /> 2 ways and the setbacks required along <br /> , <br /> ` them and at the intersection. <br /> /- 0S <br /> =,DI PERMIT FEESZ)ii °' <br /> .2 ?i <br /> Subdivision $15.00 <br /> PAN) Land Use 1.00 <br /> • <br /> Building 5.00 '•. <br /> w Sanitary 10.00 "1 <br /> Well 5.00 <br /> f/14,P N <br /> Septic Tank 110 <br /> 6021 Combination Building, Sanitary <br /> (6a and Well 5.00 <br /> / r Privy 5.00 <br /> � it .,�.- z) -sue• <br /> 7_ /8& 78 AO. <br /> ,..,i .D.cryt,c4 <br /> Signature of Owne Date ing • .m in-istrator <br /> Inspection Dateif l 1 D Inspector .7 / -.roger1n ' <br /> Remarks e-j,t i /1 r.4 'C 76aaa; e t7 7 <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 />