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Burnett County Office of Zoning Administrator �� H iz <br /> CDm o —e- <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT -0 3CD <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a -1 �± o \ <br /> Permit for the work described and located as shown herein. The undersigned agrees that all d y <br /> work shall be done in accordance with the requirements of the County Zoning Ordinance, x co <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- - o_ 1\1 <br /> 1 lations of the State of Wisconsin. � � _ — <br /> Jim\ I) C Ev <br /> co O Owner or Agent (please print) Contractor o� trrvep u, V (� <br /> ' , 4 _ CD <br /> c <br /> W �-8STDk CD r �, <br /> Address Address a vi N. <br /> y66 - 7 S— L/ r* <br /> Phone Phone v j <br /> Plumber Well Driller <br /> I <br /> NJ 0 <br /> Address Address 't 2 n o `�O c <br /> r+ < <br /> O. <br /> Phone Phone CD y I— <br /> n ,.+ O <br /> CD O ''. <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: <br /> Type of Construction No. Bathrooms o z -o <br /> 1. Work No. Bedrooms O,\ CD "4� <br /> New Building ✓` Size . . . ft. x . -3.(c_, ft. Septic Tank Size Gals. r <br /> Addition Height <br /> ht Stories . . �. W V <br /> Sanitary Area ,Y 6 y 7a.Absorption Field Site: , <br /> Filling Soil Type t vN o <br /> Moving 5. Permits Required Slope . <br /> Grading Subdivision Perc. Rate t\ <br /> Mobile Home Sanitary Dry Well SLi co m <br /> Privy Building , ,✓. Seepage Trench fD CD <br /> Well Well Privy to to �l ; ;/'''' <br /> Subdivision Other (Specify) Seepage Bed y o • <br /> N � <br /> Conditional <br /> c CD <br /> 2. Classification R k Z Land Use -../ o- * <br /> Zoning Dist. V <' o <br /> 6. Use (describe exactly, 1 -fam. (c') y: <br /> 3. Lot Size �i _ home, motel,etc.) FOR COMMERCIAL USE o <br /> �./. .CJ. , ft, x . ✓ :� . ft. �� p n RA Plans Submitted ^) <br /> sq. ft. Plans Approved �. kg <br /> _ Z Fig. A. LP / Location of proposed structures and -I <br /> �_V existing structures, well, sewage sys- o <br /> tems, roads, etc., should be sketched 3 <br /> in Fig. A. Include road setback, side v 3- <br /> '� and back yard dimension and location Q 'a <br /> ' and setback from all bodies of water. `'� T <br /> �X1Si rA,rs 5-6 I If property is located at a highway in- - Q}• <br /> 1::::( <br /> (� tersection, show the intersecting high <br /> • ways and the setbacks required along <br /> ��{, them and at the intersection. <br /> m <br /> ilk <br /> PERMIT FEES <br /> 0STi I. `CD <br /> Subdivision $46"96 co <br /> SvGc� Land Use ,.00 <br /> Building ®® N <br /> �Cl�> Sanitary — aG0 <br /> Well /a - <br /> Septic Tank 10.00 <br /> \II/ Combination Building, Sanitary669 <br /> J. and Well tbs <br /> Privy 5.00 <br /> p 0 c P( LA-lC� <br /> (1d.he _ <br /> .5-1/4-6 ? <br /> d..),AALeJ29„,ature of Owner or Agent Date Zoni ministrator <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 be made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />