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- ( '1 7L <br /> f C__ <br /> Burnett County Office of Zoning Administrator o Z <br /> CD CD ID 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT -o B ° <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a �i ' o 01 <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, 7- C <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- to a <br /> lations of the State of Wisconsin. - a CA <br /> O <br /> tA,P4 ,1 f A-RkliFZ--L . , ) <br /> Owner or Agent (please print) Contractor or Surveyor NO. <br /> ` „. rr, <br /> 5iO 9 g SO4f E' Q O F`, <br /> Address `iid(5 N Address . {u �ii I <br /> m 1n <br /> Phone Phone 1/� <br /> -01 <br /> Plumber Well Driller <br /> v <br /> �l <br /> Address Address ; C) <br /> n o <br /> < <br /> o. ,rt <br /> Phone Phone m y r <br /> 0 ,, o <br /> . o - <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities f -o - <br /> Type of Construction No. Bathrooms . .I. 2.. z z <br /> 1. Work (al b rf. Dishwasher ° o C <br /> New Building . .x . . Size :4,4P. . ft. x . .3.(ca ft. Garbage Grinder :-- <br /> Addition Height Stories Autom. Laundry . .S( . . 0 Q.) E. <br /> Sanitary . .,Z� . . Area No. Bedrooms m <br /> Alterations Waste Disposal System *3 ( ,` '`2f Moving 5. Permits Required Septic Tank Size Gals. .7.b.0 •--� V <br /> - Wrecking Subdivision Absorption Field Site v` <br /> Mobile Home Sanitary >s Soil Type 5 '_t }� CD CD-1 N <br /> S- Privy Building . . ,�s,. . Slope '7 �j® D <br /> Well . . , . Well . . .��+. Perc. Rate I 4¢ ift '� <br /> Subdivision Other (Specify) Dry Well o V` <br /> Conditional Seepage Trench J N C/) <br /> 2. Classification Land Privy c , cr 0 <br /> Zoning Dist. Seepage Bed rgr.?.3. { 0 - o <br /> • <br /> 6. Use (describe exactly, -fam. ' <br /> 3. Lot Size ome motel,etc.) FOR COMMERCIAL USE ) ° <br /> �p� C <br /> . . f.0c.'. . ft. x . ,�,.0. . ft. Plans Submitted I <br /> sq. ft. Plans Approved 0 <br /> L _ NJ <br /> Fig. A. Location of proposed structures and H <br /> existing structures, well, sewage sys- 4. o <br /> / tems, roads, etc., should be sketched <br /> ' <br /> in Fig. A. Include road setback, side `� 3 <br /> it and back yard dimension and location -a <br /> y and setback from all bodies of water. <br /> 76 tw,>-/?� If property is located at a highway in- <br /> tersection, show the intersecting high- <br /> 1c. ways and the setbacks required along <br /> them and at the intersection. 4., <br /> 750 2•5- PERMIT FEES V (�� <br /> r VIAup <br /> '�` `1� li <br /> _ ✓ Subdivision $15.00 rs• <br /> 161 ,,,, <br /> Land Use 1.00 t? <br /> 01 <br /> Building 5.00 g' <br /> 2VX IYA-d Sanitary 10.00 <br /> I Well 5.00 <br /> S 1 Septic Tank 0009), <br /> Combination Building, Sanitary <br /> 4....., and Well 15.00 <br /> C7. <br /> r <br /> ` <br /> C g'—‘71-77 SOJI/CASi2"\'°i- .7,---ell,-- <br /> Signature of Own•r'or - gent Date Z nin Administrator <br /> ,�1 <br /> Inspection Dated .." / 97/ Inspector .. r U.I , <br /> RemarksCil....,... '`_ 7--- `fZ (/ !--( Gl...; <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 />