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1 ! Y <br /> Burnett County Office of Zoning Administrator C - o <br /> APPLICATION FOR SANITARY — LAND ;}SE BUILDING PERMIT <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 <br /> work shall be done in accordance with the requirements of the County Zoning Ordinance, CD <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- <br /> CD <br /> lations of the State of Wisconsin. _ C .� <br /> Owner or A�ent (please print) Contractor or Surveyor <br /> c . <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ; <br /> Address Address <br /> 7 -2 s`�. . . . . . . . . . . . . . . . \. '� <br /> Phone _ � Phone <br /> i <br /> ... . . . . . . . . . . . <br /> . . . . . . . . . . . . . . : <br /> Plumber Well Driller : T <br /> Address Address CD <br /> U n O "1 <br /> h. < : �- <br /> O r <br /> . . . . . . . . . . . . . . . . . . . . . . . . .Ph. one. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> Phone 0 h o <br /> CD 0 <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities <br /> Typ�.sf Construction No. Bathrooms . . . ./. . z z o <br /> 1. Work > 1'rll vvf% Dishwasher <br /> New Building Size ft. Garbage Grinder <br /> Addition Height . . . . . Stories . . . . . . Autom. Laundry __ <br /> Sanitary Area . . . . . . . . . . . . . . . . . . . No. Bedrooms �. . . r <br /> Alterations . . . . . . Waste Disposal System . . . . . . ° <br /> Moving 5. Permits Required Septic Tank Size Gals. 7S70 <br /> Wrecking . . . . . . Subdivision . . Absorption Field-Site <br /> Mobile Home Sanitary Soil Type . . . . .`. " m CD <br /> `° <br /> Privy Building Slope . . . . . . . . . . . . . . . . . . . . CD CD :T <br /> f <br /> Well . . . . . . Well . . . . . . Perc. Rate . . . . . . . . . . . . . . . . . <br /> Subdivision . . . . . . Other (Specify) . . . . . . Dry Well . . . . . . o <br /> Conditional . . . . . . Seepage Trench . . . . . . ;C.., N <br /> 2. Classification Land . . . . . . Privy o <br /> Zoning Dist. ✓ . Seepage Bed . ... . . ' I <br /> 6. Use (describe exactly <br /> 3. Lot Size � home, motel,etc.) FOR COMMERCIAL USE o_ :L, � <br /> ft. xO . . . ft. Plans Submitted :� :Q.• <br /> . . . . . . . . . . . . . . . . . . sq. ft. Plans Approved . . . . . . Z.�! <br /> ----------------------------------------------------------------- <br /> Fig. A. Location of proposed structures and _ <br /> existing structures, well, sewage sys- o <br /> tems, roads, etc., should be sketched _ <br /> �.J 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- <br /> tersection, show the intersecting high- 4, i4 <br /> ip� p , � ways and the setbacks required along _ <br /> them and at the intersection. _ <br /> PERMIT FEES <br /> Subdivision . . . . . . . . . $15.00 fD <br /> Land Use . . . . . . . . . . . 1.00 <br /> Building . . . . . . . . . . . 5.00 <br /> Sanitary . . . . . . . . . . . 10.00 :cr\ <br /> Well . . . . . . . . . . . <br /> Septic Tank . . . 1.00 <br /> Combination Building, Sanitary <br /> and Well . . . . . . . 15.00 <br /> N <br /> ......... .1 -� `. .. . ..... <br /> Sign tur o caner or Agent Date Wing ministrator <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 />