Laserfiche WebLink
i <br /> Burnett County Office of Zoning Administrator Cn -n 0 z <br /> m m n) ° <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT ° 3 C <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a ° <br /> Permit for the work described and located as shown herein. The undersigned agrees that all <br /> work shall be done in accordance with the requirements of the County Zoning Ordinance, 77 CD <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- - Q <br /> lations f the State of Wisconsin. /� l O <br /> G / / /^/�/ — �) r, CD <br /> Owner or Agent (plea e rint) ntractor or Surveyor <br /> I. . . . . �.. .�. - . . . . . .O;dd ` . . . . . a <br /> d r� . <br /> ress a <br /> CU <br /> CD <br /> Phon Phone <br /> Plumber Well Driller f <br /> o <br /> Address • � � � � � � � � � � � � � � � � � Address <br /> CD o <br /> 0 0 <br /> ! o' + <br /> Phone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Phone �er- kill <br /> CD <br /> � °- <br /> D ESC R I PT I O N 4. Building Details 7. Sanitary Facilities: <br /> Type f Construction No. Bathrooms f o Z °a <br /> 1. Work No. Bedrooms . • .. • ° CD <br /> New Building v Size . . . . . ft. x . . . . . . ft. Septic ank Size Gals. <br /> Addition h. . Height . . . . . Stories . . . . . . 5 <br /> Sanitary 7a.Absorp ion Field Site: �`` <br /> . . . . . <br /> Filling Area Soil Type . . . . . . . . . . . . . . . . . . ;W :p o <br /> Moving . . . . . . 5. Permits Required <br /> Slope ` <br /> • • • • • • • • • • • • • • • • • • ' ' T ' <br /> Grading . . . . . . Subdivision . , . . . . Perc. Rate . . . . . . . . . . . . . . . . . <br /> Mobile Home . . . . . . Sanitary l� Dry Well . . . . . . CD CD <br /> Privy . . . . . . Building • • . . . . Seepage Trench . . . . . . fD <br /> Well . . . . . . Well Privy G <br /> Subdivision Other (Specify) Seepage Bed 7, 0 <br /> cn cn <br /> Conditional . . . . . . { ° <br /> 2. Classification Land Use . . . • . . \ a <br /> Zoning Dist. �( ._ . \�� <: ° <br /> 6. Use (describe exactly, 1 fam. <br /> N <br /> 3. Lot Size ome, otel,etc.) FOR COMMERCIAL USE o <br /> ° \ „ <br /> }�'. . . ft. x . . . . . . . ft. fv� � Plans Submitted . . . . . . <br /> /.? . .�. . . sq. ft. c:P ,� Plans Approved . . . . . . <br /> ___ : <br /> 9• A. Location of proposed structures and <br /> existing structures, well, sewage sys- 0 <br /> tems, roads, etc., should be sketched r <br /> in Fig. A. Include road setback, side (' <br /> and back yard dimension and location \ <br /> 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 /> PERMIT FEESLa <br /> :T <br /> Subdivision . . . . . . . . . $15.00 ` 6` fD <br /> Land Use . . . . . . . . ,�10 <br /> 100 ' <br /> Building . . . . . . . . �(J` <br /> Sanitary . . . . . . . . . . . <br /> Well 5.00 'b <br /> Septic Tank . . . . . . • • • 10.00 <br /> Combination Building, Sanitary <br /> and Well . . . . . . . . 15.00 <br /> Privy . . . . . . . . . . . . 5.00 <br /> ..................g. .at ................r A. <br /> / .....®r/ ..Si nature of Owner or A � te Z ing ministrator <br /> InspectionDate ................................... .. Inspectpr ................................................................................................ <br /> ;� . ....C4G`..... <br /> Remarks .. <br /> r 0 <br /> "XT� <br /> S.. .... .............�ot. ..... -x,......Car.f/( F..1��. ... ..... ........ ... <br /> r... ... ...... ... ... . � . <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 />