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Burnett County Office of Zoning Administrator N v O Z <br /> m m m ° ° <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT ° 3 <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 <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- o <br /> lations of the State of Wisconsin. 3 a O <br /> Ad 7-rAFf, x <br /> . . . . . . . . . . <br /> . . . . . . . . . . . . . . . . . . . . . . . . = <br /> Owner or Agent (please print) Contr. a.ct. o. r* o. r. *S u.rv. e.yor. . . <br /> S7A447-- .609 e,45-1 <br /> Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . a <br /> Phone Phone <br /> Plumber Well Driller : �� � <br /> i k <br /> Address Address <br /> o :� <br /> 0 1 <br /> Phone Phone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . :1 <br /> m 0 O <br /> � o <br /> ° <br /> DESCRIPTION 4. Building Details7. Sanitary Facilities: ° 'D <br /> Type of Construction �. . , z <br /> No. Bathrooms • • • ° z o� <br /> 1. Workfj p�//2u o�C•. . . . . . . . . . No. Bedrooms aZ. . . ° �O <br /> New Building . . . . . Size . .(p, ft. x . ./,`f:. ft. Septic Tank Size Gals. <br /> Addition Height . . .W§tories . I. . . . . . . . . � Q (_.z <br /> Sanitary 9! : Area . . . . . . . . . . . . . . . . . . . 7a.Absorption Field Site: IN <br /> Soil Type .N o <br /> Filling . . . . . . . . . . . . . . . . . . :°� :� <br /> : P <br /> Moving . . . . . . 5. Permits Required Slope . . . . . . . . . . . . . . . . . . . . <br /> Grading . . . . . . Subdivision . . . Perc. Rate : : p : tz <br /> Mobile Home . . . . . . Sanitary • , , Dry Well . . . . . . * Y <br /> Privy . . . . . . Building Seepage Trench . . . . . . m ky V <br /> Well . . . . . . Well Privy . . . . . . :1 <br /> Subdivision . . . . . . Other (Specify) . . . . . . Seepage Bed . . . . . . V\ <br /> Conditional . . . . . . N N <br /> 2. Classification Land Use . . . . . . <br /> Zoning Dist. o <br /> «� 6. Use (describe exactly, 1 -fam. H' <br /> 3. Lot Size home, motel,etc.) FOR COMMERCIAL USE ° N <br /> J 0. . ft. fA5e✓A& Rd5oRf ' N. <br /> �0:0: : :ft.x 4 $ Plans Submitted ' <br /> . . . . . . . . sq. ft. agdfM- CO r-rAGd. Plans Approved Ny : u <br /> ----------------------------------------------------------------- .� <br /> Fig.A. Location of C O <br /> /�S�rT Liq ('t= • proposed structures and <br /> existing structures, well, sewage sys- ^ 0 <br /> aOo,fT tem s, roads, etc., should be sketched :A \\\ ° <br /> u in Fig. A. Include road setback, side i? <br /> M and back yard dimension and location ;Ry -o <br /> (ypr and setback from all bodies of water. ilk <br /> If property is located at a highway in- <br /> tersection, show the intersecting high- ie <br /> p �,i• <br /> Ay a�j�s sf( ways and the setbacks required along <br /> them and at the intersection. <br /> PERMIT FEES ;® <br /> 1P /' q 00;ridAtl f"�. Subdivision.....$25.00 + $2.00 per lot. <br /> ` Land Use................................. $10.00 <br /> K® 0 <br /> n Building................................... 10.00 ;� <br /> �(/ a Sanitary ....................ti .9.74. 20.00 Fk <br /> Well ........................................ 10.00 <br /> Septic Tank ............................ 10.00 <br /> AGPrivy ....................................... 5.0 <br /> Lei <br /> Piz IVB?`G 0� <br /> f/-7— <br /> ................... . . ............................. �N . .. <br /> Si nature of Owner or Agent Date Zoning <br /> Zonin Adminis ator <br /> Inspection Date .(�............................................ Inspector/. ��` . ..... ..... ..... ........................................... <br /> Remarks ... ......`1` ......... <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 />