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DA ccykp <br /> Burnett County Office of Zoning Administrator <br /> N 'v p —i Z <br /> d 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT '0 CD <br /> C> 0 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application fora � '� o :W Permit for the work described and located as shown herein. The undersigned agrees that all N <br /> work shall be done in accordance with the requirements of the County Zoning Ordinance, 77 <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- -CD <br /> ° <br /> lations of the State of Wispprisin. 0 <br /> Owner or Agent (please pri t) Contractor or Surveyor <br /> �. - . . . . . . . . . . . . . . . . a <br /> 4- d . r.ess Ad edf ss <br /> .. - . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> Phone Phone \ ` AIL <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> Plumber Well Driller <br /> Address Address c o <br /> o <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> Phone Phone m m <br /> 0 - o <br /> CD �* <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: <br /> Type of Construction No. Bathrooms • • • • • • o Z 0CD <br /> 1. Work No. Bedrooms • • • • • • ° <br /> New Building Size �. ft. x,3 ft. Septic Tank Size Gals. . . . . . . <br /> 4 . . <br /> Addition . . . . . . Height .f .`. Stories . • • • • • • <br /> ��j b 7a.Absorption Field Site: r. <br /> Sanitary . . . . . . Area �� 'I � <br /> Filling . . . . . . Soil Type o <br /> Moving . . . . . . 5. Permits Required <br /> Slope <br /> Grading . . . . . . Subdivision . • . . . • Perc. Rate . . . . . . . . . . . . . . . . . <br /> Mobile Home . . . . . . Sanitary Dry Well . . . . . . m � <br /> Privy . . . . . . Building M CD <br /> Seepage Trench . . . . . . <br /> Well . . . . . . Well . . . . . . Privy . . . . . . <br /> Subdivision . . . . . . Other (Specify) . . . . . . Seepage Bed P <br /> Conditional . . . . . . N N <br /> c 0 <br /> 2. Classification -/ Land Use . • . • • . 6 <br /> a <br /> Zoning Dist. . 'L ` < 0 <br /> 6. Use (describe exactly, 1 fam. y <br /> 3. Lot Size home, motel,etc.) FOR COMMERCIAL USE <br /> ft. ft. Plans Submitted . . . . . . <br /> .�•�i.�!"". sq. ft. Plans Approved <br /> -------------------------- ------ ------------------------------- <br /> Fig. A. Location of proposed structures and <br /> existing structures, well, sewage sys- ^� 0 <br /> �- tems, roads, etc., should be sketched xJ <br /> in Fig. A. Include road setback, side "` s <br /> " and back yard dimension and location R( <br /> and setback from all bodies of water. <br /> If property is located at a highway in- <br /> tersection, show the intersecting high- y� <br /> / ways and the setbacks required along <br /> them and at the intersection. <br /> JV, PERMIT FEES <br /> `t Subdivision.....$25.00 + $2.00 per lot. fD <br /> Land Use................................. $�. O <br /> Building................................... <br /> Sanitary .................................. <br /> Well ........................................ 10.00 ` <br /> Septic Tank ............................ 15.00 <br /> Privy 5.00 <br /> ........... . . -'/�e� ..e..n..t.Si nature .��. .. <br /> ;d; ei� i�s�tr or <br /> InspectionDate ................................................ Inspector ................................................................................................ <br /> Remarks .............................................. <br /> .............................................................................................................. <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 />