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-Burnett County Office of Zoning Administrator o H 6.1 <br /> CD CD DO 0 0 <br /> 'APPLICATION FOR SANITARY — LAND USE BUILDING PERMIT °. 3o <br /> 'TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a -I - o <br /> 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, cp <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- a <br /> lations of the State of isconsin. p <br /> 2 <br /> . . .hnt7-4, 4c JL, y Jell j <br /> Owner or Agent (please print) r� Contractor of Ou.„.y.r y \.1 :ifo r �'iC 3.- S T a i <br /> a. <br /> Address Address a I 7 <br /> s-'777iiwc` r MA (net s5ol <br /> Phon Phone ---.... r6 <br /> cf nS <br /> Plu ber 1 Well Driller <br /> �F r <br /> � <br /> Address Address G) <br /> Phone Phone \j -� o <br /> CD ° rr 4.. <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: j ° <br /> Ei <br /> Type of C ns rf#, No. Bathrooms <br /> o z <br /> 1. Work / / No. Bedrooms ° m <br /> New Building f�' Size ft. x .��77 ft. Septic Tank Size Gals. <br /> Addition Height Stories 7 tr ( t , '� <br /> Sanitary . . Area 7a.Absorption Field Site: ft ��^' m <br /> FillingSoil Type -- -N o <br /> Moving5. Permits Required Slope -- <br /> Gradi g Subdivisionq Perc. Rate v' v <br /> Mobile Home Sanitary Lr- Dry Well CP�}� m .-. �� <br /> Privy Building .(� Seepage Trench lJ t fD CD <br /> Well Well t. Privy 1 6.3 <br /> Subdivision Other (Specify) Seepage Bed /,f` V o :� ti N <br /> Conditional . <br /> — <br /> ° CD <br /> 2. Classification 2Land Use ( °- <br /> Zoning Dist. a . . . . ' 7- a' <br /> 6. <br /> 6. Use (��escribe exactlyam. y' <br /> 3. Lsot iz homeirrtotel, etc.) FOR COMMERCIAL USE ° <br /> oZ <br /> ft. x Q.A . . ft. Plans Submitted -' <br /> sq. ft. Plans Approved 4 1-1 <br /> - ,tom <br /> Fig. A. Location of proposed structures and r--, <br /> fisting structures, well, sewage sys ° <br /> iLt <br /> �C�� �,�. ��Cterns, roads, etc., should be sketched <br /> � in Fig. A. Include road setback, side • s <br /> 'j� and back yard dimension and location6 ?- a <br /> , �t / � and setback from all bodies of water.-t `` <br /> If property is located at a highway in h C3 <br /> �� _.Z4. ' tersection, show the intersecting high- in Vti <br /> fli'e ways and the setbacks required along E ^ <br /> le‘CI _______JI them and at the intersection. � LQ1 . ` <br /> 150I \IPII‘ PERMIT FEES 71 <br /> Subdivision $R' 4 <br /> Land Use VON 1 <br /> Building .1' • <br /> Sanitary " 1 e <br /> Well d 7 E <br /> W r i ( Septic Tank 10.00 - <br /> Combination Building, Sanitar O <br /> ® and Well 15.00 7' <br /> Privy 5.00 <br /> 5 <br /> - , <br /> R - ,......,,--(1._ 11,2 /-7 caA/ I <br /> Signaure of Owner or Agent Date o . Administrator <br /> Inspection Date `1 7q Inspector ../..e�� �{1 � � <br /> Remarks S-.!jr... 1 `- `V C -w �2.o fZl , 7� • .- .... .:-c... <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 />