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Burnett County Office of Zoning Administrator <br /> o --ic <br /> APPLICATION FOR SANITARY — LAND USE - BUILDING PERMIT 73 3 o <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 co y <br /> work shall be done in accordance with the requirements of the County Zoning Ordinance, x. �y <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- -a °- ) G^ ' <br /> latio s of the State of Wisconsin. a <br /> 3 v G O <br /> ti! 4 Vv�n Y S' a C r•wy. R h Y' ! C C r•, v�-,. $• '+ m <br /> Owner or Agent (please print) Contractor or Surveyor H <br /> Address Address a NI Az <br /> c. <br /> t cZ c t ii dA. ,r-- / dq `= <br /> Phone Phone <br /> 1-. (a %� ( h `�y1 NI <br /> Plumber Well Driller <br /> G <br /> Address Address NiI f 0 <br /> � a o <br /> Phone Phone CD th I <br /> CD o ° / <br /> D ESC R I PT ION 4. Building Details 7. Sanitary Facilities <br /> Type of Construction No. Bathrooms z z o <br /> y <br /> 1. Work ! rc4 dm". '- Dishwasher o o CD <br /> 0 <br /> New Building 4-----.- ^Size . Li. ft. x . .:3.c" ft. Garbage Grinder VIAddition Height Stories Autom. Laundry F <br /> Sanitary . . Area No. Bedrooms ��, / "() m <br /> Alterations Waste Disposal System /���7 o <br /> Moving 5. Permits Required Septic Tank Size Gals. 1.- H_ P <br /> Wrecking Subdivision Absorption FielcI ite / <br /> Mobile Home Sanitary Soil Type k @ m m <br /> Privy / Building ✓ Slope / � CD CD <br /> _ f <br /> Well . L.( . Well . .(;.! Perc. Rate . '" t. . . . . . <br /> Subdivision Other (Specify) Dry Well . — <br /> Conditional Seepage Trench ci ,.I . cn Cl) <br /> CD <br /> 2. Classification f�_� Land Privy ,fit — ' c h <br /> Zoning Dist. Seepage Bed /. s7 y-" A -. oa ' <br /> 6. Use (describe exactly, 1 -fam. `": <br /> 3. Lot Size home motel,etc.) FOR COMMERCIAL USE t 6 <br /> i e . ft. x .I`.1``i. . ft. Plans Submitted <br /> sq. ft. Plans Approved <br /> Fig. A. Location of proposed structures and —Iexisting structures, well, sewage sys- `' o <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- <br /> S o 7 isi Ai tersection, show the intersecting high- J <br /> 4ways and the setbacks required along t <br /> /jam' them and at the intersection. <br /> � P. r <br /> Lio,eodi,":4 , ...___LiyS� Cam-- PERMIT FEESf,l �-f "a.0 -Subdivision $15.00 fD <br /> w �' ill <br /> .19 c'�� e.4eIa"d=""Land Use 1.00 <br /> / a : ) . a trw Building 5.00 0 <br /> Sanitary 10.00 '7s j <br /> 1 Os Well 5 <br /> Septic Tank 1.00 <br /> ` Combination Building, Sanitary <br /> and Well 15.00 <br /> °Allefet/X-4) <br /> 5") 1-77 . .. <br /> Sign tune` �f caner or Agent Date / nin dministrator <br /> Inspection Date G 7` / 7 77 Inspector <br /> Remarks // ..„62( (-,z."-i`- _ <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 />