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Burnett County ` Office of Zoning Administrator v U Cl) o z <br /> CD CDED 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT �, CD <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a — 0 <br /> Permit for the work described and located as shown herein. The undersigned agrees that all m <br /> work shall be done in accordance with the requirements of the County Zoning Ordinance, x- cp \ <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- m °- <br /> lations of he St te of Wisconsin. ` / / p 0 <br /> er S F 5 if/Jre.c 4 / C� o NJ•' 7.. <br /> / C 0 �2' s S e ZJ� — <br /> wner or Agent (please print) Contractor or Surveyor y may^ <br /> = • <br /> � � <br /> ‘...?5'-_3‘...?5'-_3 F„ , / / /p pr ,`ve a , <br /> Address Address o �� <br /> q 4, 6r a uc / " ' y n/ --c4N <br /> ° <br /> Phone <br /> '� Phone <br /> ss��9 k <br /> Plumber Well Driller sNC <br /> Address Address 7 o <br /> r+ <br /> o .: <br /> Phone Phone C 0 <br /> CD N r <br /> 0 ,, 0 <br /> CD 0 <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: -o <br /> Type AC nstr ion No. Bathrooms o z 0a <br /> 1. Work No. Bedrooms o <br /> New Building v Size ./4 . . ft. x . Rd,. ft. Septic Tank Size Gals. N '' <br /> Addition Height . 2. . Stories <br /> / kki <br /> Sanitary Area 7a.Absorption Field Site: -4— �. r <br /> Filling Soil Type o <br /> Moving 5. Permits Required <br /> Slope <br /> Grading Subdivision Perc. Rate -'C.. <br /> Mobile Home Sanitary ✓ Dry Well 1 'CD C <br /> Privy Building Seepage Trench N. <br /> 0 fD fD <br /> Well Well Privy —te k <br /> Subdivision Other (Specify) Seepage Bed 0') o o N <br /> Conditional 0 <br /> 2. Classification Land Use 0a CD <br /> Zoning Dist. ��. . . W <' 0 <br /> 6. Use (describe exactly, 1 -fam. E H \ <br /> 3. Lot Size home, motel,etc.) FOR COMMERCIAL USE --I0 <br /> ft. x ft. '11�// - Plans Submitted <br /> 9 <br /> sq. ft. Cfi'z'•� Plans Approved r—--. f <br /> R` j <br /> Fig. A. Location of proposed structures and • <br /> existing structures, well, sewage sys- o <br /> tems, roads, etc., should be sketched <br /> 0 <br /> I „ r in Fig. A. Include road setback, side 4 '- <br /> sGC ���51r� and back yard dimension and location K o, <br /> 1" e a` R 6 'N and setback from all bodies of water. (� (� <br /> \ If property is located at a highway in- <br /> tersection, show the intersecting high Z, , <br /> Li ways and the setbacks required along U.) (T� <br /> LA /G them and at the intersection. <br /> /�r .,___) PERMIT FEES V <br /> Ml <br /> Subdivision $25.00 + $2.00 per lot. fD <br /> Land Use $10.00 � : <br /> Building 10.00lk <br /> Sanitary 20.00 <br /> Well 10.00 <br /> Septic Tank fiA/.5%� <br /> Privy 5.00 <br /> ,./7 ('' ''-e" ---1 ..-- ....7/ <br /> Sigrt'ature of Owner or Agent ate Zo i inistrator <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 />