Laserfiche WebLink
• -AI;, ," , <br /> Burnett County Office of Zoning Administrator N o z <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT - - ° <br /> TO `THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a = o <br /> —I Permit for the work described and located as shown herein. The undersigned agrees that all d <br /> work shall be done in accordance with the requirements of the County Zoning Ordinance, m <br /> I <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- -oo_ 0 <br /> la io s of the State of Wiscon in. f, <br /> 4 4 Y" 90 r \-S—"'r 1 r 3 <br /> Owner or Agent (please print) Contractor or Surveyor N \ <br /> 741 �7 8r b /s�.r kip a -----:- <br /> Address Address a '�1„. <br /> d <br /> ur4 Ain ss�/I � ci; �. � <br /> Phon Phone 7 <br /> 1 14-194";—'1 <br /> t N.N... <br /> Plu ber Well Driller 7' <br /> W <br /> O a\ <br /> Address Address CD G <br /> n o <br /> N.S4 < <br /> o '+ `r—, <br /> Phone Phone cco H m ,c <br /> o r, o <br /> CD o r' C <br /> DESCRIPTION 4. BuildingDetails v c <br /> 7. Sanitary Facilities: f 7 <br /> Type of Construction No. Bathrooms z z ° <br /> 1. Work / F + a ''^ "e. No. Bedrooms 'a— ° CD <br /> New Building L✓ Size .afit'. ft. x . 3 !fir. ft. Septic Tank Size Gals. .'.7.J. 9 '* <br /> Addition Height Stories <br /> Sanitary �� Area 7a.Absorption Field Site: C <br /> Filling Soil Type " [_ <br /> Moving 5. Permits Required Slope f" P. <br /> a '� � <br /> Grading Subdivision Perc. Rate <br /> fl <br /> 01 <br /> Mobile Home Sanitary L — Dry Well m �� <br /> Privy Building L...---- Seepage Trench -c/ <br /> Well . .(.�� Well `/ Privy U`fr) n!� ` 1 '1 <br /> Subdivision Other (Specify) Seepage Bed i Ut v} n <br /> Conditional \% �_ N <br /> 2. Classification Land Use ``. ` `'c <br /> p rT <br /> Zoning Dist. RR-A . `� s a `o' <br /> Ka 6. Use (describe exact) 1 fam. A..)N A.`H: ' <br /> 3. Lot Size home, motel,etc.) y FOR COMMERCIAL US a , 'f °-�I...... <br /> . t . 0 ft x yOU ft. Plans Submitted <br /> sq. ft. Plans Approved - 7' ---- j <br /> Fig. A. Location of proposed structures and <br /> existing structures, well, sewage sys- • o <br /> tems, roads, etc., should be sketched h <br /> in Fig. A. Include road setback, side <br /> and back yard dimension and location -o <br /> and setback from all bodies of water. 5%, <br /> If property is located at a highway in- , <br /> tersection, show the intersecting high- C <br /> � ' <br /> h <br /> ways and the setbacks required along (0 them and at the intersection. <br /> rfr,..(..„._ \.../D3 <br /> { PERMIT FEES A <br /> \ Subdivision $25.00 + $2.00 per lot. to <br /> (1) <br /> Land Use $10.00 �\ <br /> 10.00 <br /> Cuildingl <br /> anitary 35.00 <br /> ell 10.00 g11 <br /> Privy <br /> A- <br /> 30 /91i SOS' <br /> Signatur of Owner or Agent Date Zoning Administrator <br /> Inspection Date 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 he made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />