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Burnett County --Office of Zoning Administrator (--4 lcr) _f l /I) - 2. <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT -0 - <br /> CD <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a ^H - <br /> o <br /> Permit for the work described and located as shown herein. The undersigned agrees that all c. H .. ~' U" <br /> work shall be done in accordance with the requirements of the County Zoning Ordinance, ,r C <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- v °- C-- <br /> lations of t_1he State of�Wisconsisin. eL <br /> \. <br /> Owner or Agent (please print) Contractor or Ne.-ci S rveyor a cci, , ,, .. -- 3 a) <br /> H CD <br /> col O <br /> 7 0 MInter pass I V)plS • ) Mlhh Q <br /> Address �� 5 Address a <br /> /z- 5-7/ -0 7S 7 (431-L3'7f ---C�0 --00 7 JNt S <br /> Phone Phone .� S, <br /> Neect Coçk <br /> , `� �;. . . iU ; <br /> Plumber Well Driller <br /> a _ — <br /> Address \ Address <br /> -6-6 d ` V V 7 0 1J lO P f/` ~7 o 0 U <br /> Phone Phone Do <br /> � y r <br /> 0 _ o <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: r 1: ° N <br /> Type of Construction No. Bathrooms n: . Z z o <br /> 1. Work J1 DU e `E 9. ALL a E'- No. Bedrooms ° oCD <br /> New Building Size . .'c ft. x . .3.Z ft. Septic Tank Size Gals. /.;1. ?= �� V1 <br /> Addition Height Stories <br /> Sanitary . . 1--:":-. Area 7a.Absorption Field Site: tr <br /> Filling Soil Type . . . - �' � r <br /> Moving 5. Permits Required Slope <br /> Grading Subdivision Perc. Rate q /A( y4 :'" '7 <br /> Mobile Home Sanitary Dry Well m m .-4. <br /> Privy Building Seepage Trench fD �D <br /> 4// 'v <br /> Well ✓ Well Privy ,-- te <br /> Subdivision Other (Specify) Seepage Bed d YX-. 0 oo 7,/ .- <br /> Conditional (3'' 0 -7) cn to <br /> 2. Classification Land Use I o <br /> 0 <br /> Zoning Dist. C - o' <br /> 6. Use (describe exac 02 !'� • <br /> 3. Lot Size home, motel,etc.) FOR COMMERCIAL USE ° <br /> • . ft. x ft. Plans Submitted 'Z ° <br /> �' j 6 /j0 , sq ft. Plans Approved <br /> Fig. A. Location of proposed structures and <br /> existing structures, well, sewage sys- O o 0 <br /> tems, roads, etc., should be sketched <br /> in Fig. A. Include road setback, side <br /> ,-7 6 and back yard dimension and location o <br /> and setback from all bodies of water. <br /> ti- 4i If property is located at a highway in- <br /> .b�'�` tersection, show the intersecting high 1 <br /> 9- (� ( , <br /> `u ways and the setbacks required along (V <br /> 4' <br /> �\ �.5----- them and at the intersection. 3 <br /> i''. lam' O PERMIT FEES �i <br /> 47 C— I Subdivision $15.00 cocn <br /> Land Use 1.00 r <br /> t''` <br /> ��/ Building 5.00 AF Sanitary 10.00 <br /> ' Q EII:l <br /> WellSeptic TankCombination Building, Sanitary <br /> �� i and Well 65.00) <br /> ,/ Privy 5.00 <br /> &(-7- <br /> Signature of Owner or AgentDat� 77 '8) (--- .01 - <br /> i <br /> 9 Admi istrator <br /> Inspection Date ` l ry - 7 Inspector ` 0 <br /> Remarks 0 -CO, <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 /> 4 Ait fm•v, -41-„ aliQ'fiiii 41 T <br />