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Burnett County Office of Zoning Administrator 07� CID o- 0' <br /> E - <br /> a 03 oCD <br /> 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 C <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a 0 h o ISS <br /> Permit for the work described and located as shown herein. The undersigned agrees that all H �. <br /> work shall be done in accordance with the requirements of the County Zoning Ordinance, <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- <br /> lations of the Stag W isconsin. CD VD O l <br /> . � � ' <br /> Ld <br /> Owner or ent (please print) Contractor or Surveyor N 4� CD <br /> N :�V <br /> CD <br /> a <br /> �. w.�S.c. . . . . . . . . . . _ <br /> Address Address <br /> 4. . . . . . . . . . . . a <br /> Phone Phone �-►iC <br /> Plumber <br /> Well Driller <br /> 0 <br /> Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . o <br /> CD0 : <br /> < <br /> Phone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Phone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> CD <br /> 0 <br /> � 0 o <br /> - <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: _0a <br /> Type of Construction No. Bathrooms . • • • • • o Z oa <br /> 1. Work . . . . . . . . . . . . . . . . . . . . . . . . No. Bedrooms . . . . . . ° <br /> New Building . . . . . . Size . . . . . ft. x . . . . . . ft. Septic Tank Size Gals. . . . . . . <br /> Addition . . . . . . Height . . . . . Stories . . . . . . <br /> Sanitary . . . . . . Area . . . . . . . . . . . . . . . . . . . 7a.Absorption Field Site: ]� <br /> Soil Type YPe • • • • • • • • • • • • • • • • • • 0 ' <br /> Moving . . . . . . 5. Permits Required Slope <br /> Grading . . . . . . Subdivision Perc. Rate . . . . . . . . . . . . . . . . . <br /> Mobile Home . . . . . . Sanitary , • . • •.. Dry Well . . . . . . CD - (� <br /> Privy . . . . . . Building Seepage Trench fD `D <br /> Well . . . . . . Well Privy . . . . . . fA <br /> Subdivision Other (Specify) . . . . . . Seepage Bed o <br /> Conditional cn cn <br /> C CD <br /> 2. Classification n Land Use . . 0 <br /> Zoning Dist. . . _. . . ° o' <br /> 6. Use (describe exactly, 1 -fam. H' _ <br /> 3. Lot Si;se home, motel,etc.) FOR COMMERCIAL USE ; <br /> ft. Plans Submitted . . . . . . o e� <br /> . . . . . . . . . s .ft. Plans Approved 1 <br /> ——————————————————————p p------------ <br /> Fig. A. Location of proposed structures and <br /> existing structures, well, sewage sys- 0 <br /> tems, roads, etc., should be sketched = <br /> in Fig. A. Include road setback, side <br /> and back yard dimension and location a <br /> and setback from all bodies of water. <br /> If property is located at a highway in- i <br /> ' tersection, show the intersecting high- <br /> ways and the setbacks required along <br /> them and at the intersection. <br /> PERMIT FEES <br /> Subdivision . . . . . . . . . $15.00 CD <br /> yd. Land Use . . . . . . . . . . . 1.00 <br /> Building . . . . . . . . . . . 5.00 <br /> Sanitary . . . . . . . . . . . 10.00 <br /> �. .� Well . . . . . . . . . . . 5.00 <br /> ?(�y Septic Tank . . . . . . . . . 1-?00 <br /> Combination Building, Sanitary <br /> and Well . . . . . . . . 15.00 <br /> 1' Privy . . . . . . . . . . . . 5.00 ... <br /> ` ..9---, -. .� .. .................... <br /> ......... �,� <br /> Signatur6 of Ow er or Ag t , Date f Zoni Administrator <br /> l <br /> InspectionDate ................................................ Inspector ................................................................................................ <br /> Remarks ............................................................................................................................................................ <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 />