2017/05/08 - SANITARY - SAN - Other

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Burnett County Office of Zoning Administrator C- z ,ARPLICATION FOR SANITARY LAND USE — BUILDING PERMIT 3 �� TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a = o Permit for the work described and located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the County Zoning Ordinance, 77 M N\3 Sanitation Code, and with all other applicable County Ordinances and the laws and regu- ° ,lations of the State of Wisconsin. 3 Y O �u�EvF. F• �� L'RRTHY. . . . cTd�. Gev2 (,� T Off. R _ Owner or A gert lease ri e _Q Contractor or Surveyor . . . y �� ,DERONA� i✓1S G 3yia� a e Address Address . . .one. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . �. . . . -. . . . . . . . . . . . . . . . . . . . . . . . . PhPhone . i) S i� Plumber Well Driller r p � p Address Address c Phone Phone m :�t o DESCRIPTION 4. Building Details 7. Sanitary Facilities: Type of Ccr ction �+ No. Bathrooms • • . o Z °o 1. Work z/. . . No. Bedrooms • • ° New Building Size ft. x . ft. Septic Tank Size Gals. .7 AS, Addition Height .1. . Stories . .. . . . . . . . . Sanitary .Ll Area . . . . . . . . . . . . . . . . . . . 7a.Absorption Field Site: / ;rl Filling Soil Type . . . .5 Q.,r? o A Moving . . . . . . 5. Permits Required Slope . . . . . . . . .f. � . . Grading . . . . . . Subdivision . . . . . . Perc. Rate . . . . . . . . . . . . . . . . . Mobile Home . . . . . . Sanitary - Dry Well Privy . . . . . . Building ��'- Seepage Trenchpq :r Well Well « Privy iaxa� Subdivision . . . . . Other (Specify) Seepage Bed o n Conditional �` (n N 2. Classification �Q,� Land Use 1 Zoning Dist. /�. . . . . . C o 6. Use (describe exactly1 -fam 3. Lot Sia Some)motel,etc.) FOR COMMERCIAL USE $ r 7 . V. . ft. x Plans Submitted . . . . . . _ T' . . . . . . . . . . . . . . . . . . sq. ft. Plans Approved . . . . . . ` ---------- ------ Fig. A. Location of proposed structures and 0 Ra,,k� "F existing structures, well, sewage sys- �� - 0 Z,AX tems, roads, etc., should be sketched _ N 1 01 in Fig. A. Include road setback, side and back yard dimension and location _ o --E7 and setback from all bodies of water. If property is located at a highway in- — - / tersection, show the intersecting high- :0 ways and the setbacks required along them and at the intersection. aa8 W►%�'L S.�wi=R � PERMIT FEES ; 14K `D Subdivision $15.00 Land Use . . . . . . . . . . . 1.00 Building . . . . . . . . . . . 5.00 (� (P Sanitary . . . . . . . . . . . 10.00 ` - -- - -- e I I . . . . . . . . i Septic Tank . . . . . 1/ 00� R Combination Building, Sanitaryr- /1 and Well . : :� 15:00 Privy . 0 1-te �X�.. . A - Signatur f caner or Ag/ent G Date �goni Administrator Inspection Date RFi..i( 7. Inspector .. ... ... 5 7 .................................... /.... Remarks ........!.... ..C ........"/�T�..f�f/^- G/��I�Z�R •!G�/� 0. +-L/../ ................................................................................................................................................................................................ ................................................................................................................................................................................................ NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to this application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build- ing until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- with is found to exist. Changes in plans or specifications shall not be made without approval of the Zoning Administrator. SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED.