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Burnett County Office of Zoning Administrator N o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT ° 3 CD <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a = o <br /> Permit for the work described and located as shown herein. The undersigned agrees that all N ?p <br /> work shall be done in accordance with the requirements of the County Zoning Ordinance, C <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- _V 0- �'V <br /> lations of the State of Wisconsin. 3 �° O <br /> !1 c �* - <br /> /. R Il. . ./ :St L. ��a�Tr//G •!t/,�. �f!✓ v�jt-✓ '. cc :N <br /> Owner or Agent (please print) Contractor or Surveyor H �� <br /> ' /�' / ` wG✓ �... <br /> kc. t j.. .m� �/? . s55!�' . . � . . . . . . . . . . . . . t. a � (A <br /> Address Address a C :11q <br /> m <br /> Phone Phone V <br /> ,14 r <br /> Plumber Well Driller <br /> Address Address CD c� <br /> o <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X <br /> o' <br /> Phone Phone CD H m <br /> n ° ILA <br /> CD o <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: :r <br /> Type of Construction No. Bathrooms • • • • • • 6 r Z ° <br /> 1. Work No. Bedrooms . . . . . . 'v. o CD <br /> New Building �� Size ; ft. x . ft. Septic Tank Size Gals. �,- <br /> Addition . . . . . . Height t Stories . ./. . . . <br /> Sanitary . . . . . . Area . . . . . 7a.Absorption Field Site: : [`�'1� : r <br /> Filling . . . . . . Soil Type . . . . . . . . . . . . . . . . . . 1 ° <br /> MovingSlope r' <br /> . . . . . . 5. Permits Required • • • • • • • • • • • • • • • • • • • • <br /> Grading . . . . . . Subdivision Perc. Rate . . . . . . . . . . . . . . . . . <br /> Mobile Home . . . . . . Sanitary Dry Well . . . . . Gi CD CD :V, <br /> Privy . . . . . . Building Seepage Trench . . . . . . C, fD `D <br /> Well . . . Well Privy . . . . . . 1 : <br /> Subdivision . . . . . . Other (Specify) . . . . . . Seepage Bed . . . . . . r"�j c <br /> Conditional �� N N <br /> c M <br /> 2. Classification Land Use . . . . . . <br /> Zoning Dist. �(�� ` °-° o <br /> 6. Use (describe exactly, 1 -fam. y' ° <br /> 3. Lot Size home, motel,etc.) FOR COMMERCIAL USE ° <br /> -ram. . 1 . . . . ft. x .ay. . . ft. �igl�M hQm,- Plans Submitted N- <br /> . . . . . sq. ft. Plans Approved <br /> --------------------------------------------- --------------- <br /> Fig. A. Location of proposed structures and <br /> existing structures, well, sewage sys- ` o <br /> tems, roads, etc., should be sketched <br /> ,f 1 � <br /> % ` in Fig. A. Include road setback, side s <br /> and back yard dimension and location <br /> yj '33 and setback from all bodies of water. <br /> `�/ " If property is located at a highway in- <br /> tersection, show the intersecting high- �•+' <br /> ways and the setbacks required along <br /> them and at the intersection. <br /> PTi0, <br /> iiy � PERMIT FEES <br /> CD <br /> , Subdivision..... $25.00 + $2.00 per lot. <br /> Land Use......................... ...... 0.00 <br /> Building......................... ..v?.'S� <br /> Sanitary .................................. 20.00 <br /> Well ........................................ 10.00 <br /> I Septic Tank ............................ 10.00 <br /> Privy ....................................... 5.00 <br /> 2vAp <br /> Sign ure wne Date Zoning A d m i trator <br /> InspectionDate ................................................ Inspector ................................................................................................ <br /> � .6- a <br /> Remarks .GU�01's<?�!.?�:G.......................�.......................................................................................................... <br /> ................................................................................................................................................................................................ <br /> ................................................................................................................................................................................................ <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 />