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Burnett County Office of Zoning Administrator <br /> o ' <br /> CD fD ,di o O <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT ' <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a CD <br /> -1 ''— <br /> of <br /> Permit for the work described and located as shown herein. The undersigned agrees that all c. y <br /> work shall be done in accordance with the requirements of the County Zoning Ordinance, ,r m QC <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- -o °- <br /> lations of the State of Wisconsin. cc o_ <br /> d <br /> 3 <br /> ) 'YRI iI. . . . 1,. . . . .4A-R/e.i.S . se,. '( .l )?.1�0. �u�/r��v G c� �� : ‘ . <br /> Owner or Agent (please print) Contractor or Surveyor H <br /> 'A / c <br /> ar .1.4\(4. . t . . ili 1. N.. CY "(/ /_ U /' �/ $ 4? CD ) rIT <br /> Add ss Address a `I / <br /> 75'—( L -707 �i <br /> PhoneS Ju <br /> Phone <br /> Plumber Well Driller �V( <br /> s1 p <br /> Address Address C 4,-) <br /> C. o <br /> o ,-, v— <br /> Phone Phone C c', r <br /> 0 - 0 <br /> CD otl <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities -E. - <br /> Typgapf Construction No. Bathrooms z z o <br /> 1. Work X .{� Y 0.YY‘ �— Dishwasher ° \ CD �- ?N. <br /> New Building Size .t.es , ft. x .3 ft Garbage Grinder ` <br /> Addition Height I Stories Autom. Laundry . . . • r <br /> Sanitary Area No. Bedrooms <br /> Alterations Waste Disposal System . . . . : 1 . <br /> Moving 5. Permits Required Septic Tank Size Gals. \z <br /> Wrecking Subdivision Absorption Field Site <br /> Mobile Home Sanitary Soil Type CD (/ <br /> Privy Building $,. . Slope CD CD <br /> Well Well Perc. Rate ( _ S� <br /> Subdivision Other (Specify) Dry Well o �l( <br /> Conditional Seepage Trench 1 cn cn <br /> 2. Classification Land Privy o- h <br /> Zoning Dist. g—. ,a. Seepage Bed . . .&.. <br /> 6. Use (describe exactly, 1 -fam. <br /> 3. Lotr§ize home, motel,etc.) FOR COMMERCIAL USE �o T <br /> d` o— : <br /> ft. x ft. ,,,,ra1„e Plans Submitted <br /> �� ) IR _ear>sq. ft. Plans Approved — T 6 <br /> �Q 1 t� y•'l <br /> Fig. A. Location of proposed structures and <br /> /V. existing structures, well, sewage sys- • —) o <br /> °RD E tems, roads, etc., should be sketched i— <br /> in Fig. A. Include road setback, side s <br /> � <br /> / T and back yard dimension and location s -o <br /> and setback from all bodies of water. <br /> 60 If property is located at a highway in- i.� <br /> ,,- Zx lk tersection, show the intersecting high- f/ <br /> ways and the setbacks required along <br /> them and at the intersection. .—:_. <br /> i PERMIT FEES <br /> �i o� CCM <br /> CM <br /> . ' Subdivision $15.00 CD <br /> 5 Land Use 1.00 . ..-- <br /> 1 # Building 5:0 <br /> . , Sanitary <br /> 13 Well 5.00 �, <br /> ip Septic Tank 1.00 <br /> Q Combination Building, Sanitary <br /> 2. A- and Well 15.00 <br /> S 4 - , /) n 1 /J 1) <br />