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-) <br /> Burnett County Office of Zoning AdministrA6r o z <br /> W o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 9. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application fora <br /> Permit for the work described and located as shown herein. The undersigned agrees that all m <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- <br /> lations of the State of Wisconsin. 3 a O <br /> �! ._.1:-/. .. a. .. N . . . . . . . . . . . . . . . . . . . `D 0 <br /> Owner or Agent (please print) Contractor or Surveyor <br /> . . �? 7'7' . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . a <br /> Ad ess Address 0- <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> � o <br /> Phone Phone <br /> y . . . � s7e� . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> Plumber Well Driller <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _ <br /> Address Address �^ 0 ` <br /> o <br /> 0 <br /> Ph <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> � N <br /> one Phone 0 o <br /> C <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: -o ~ <br /> Typ of Construction No. Bathrooms . • . . . . Z Z ° <br /> o ° o <br /> 1. Work / No. Bedrooms . . . • . . `, l <br /> New Building . . f!. . e ft. x .N.Y. ft. Septic Tank Size Gals. . . . . . . <br /> Addition . . . . . . Height . . . . . Stories . . . . . . . . . . . . v o <br /> Sanitary 7a.Absorption Field Site: \'V <br /> . . . . . . Area \ <br /> Filling . . . . . . Soil Type . . . . . . . . . . . . . . . . . . <br /> Moving . . . . . . 5. Permits Required Slope . . • " " " " " " " " ' <br /> Grading . . . . . . Subdivision . . . . . . Perc. Rate . . . . . . . . . . . . . . . . . T T <br /> Mobile Home . . . . . . Sanitary Dry Well . . . . . . <br /> Privy . . . . . . Building , . . . . , Seepage Trench . . . . . . - <br /> Well . . . . . . Well . . . . . . Privy . . . . . . <br /> Subdivision . . . . . . Other (Specify) Seepage Bed . . . . . . o > e <br /> �//yyy��� Conditional . . . . . . <br /> 2. Classification /n� Land Use . . . . . . ° - o <br /> Zoning Dis < <br /> 6. Use (describe exactly, 1 -fam. <br /> 3. Lot Slize. home, motel, etc.) FOR COMMERCIAL USE ° <br /> . .� . . ft. x 1�. ft. Plans Submitted . . . . . <br /> : � <br /> s ft. Plans Approved <br /> q <br /> ----------------------- ---- ----------------------------------- _ <br /> Fig. A. Location of proposed structures and <br /> existing structures, well, sewage sys- �__ o <br /> tems, roads, etc., should be sketched I <br /> in Fig. A. Include road setback, side iJ, i <br /> and back yard dimension and location <br /> and setback from all bodies of water. <br /> If property is located at a highway in- <br /> tersection, show the intersecting high- <br /> ways and the setbacks required along <br /> them and at the intersection. <br /> p /(� PERMIT FEES <br /> l O Subdivision..... $25.00 + $2.00 per lot. <br /> Land Use................................. $10.00 {� <br /> Building................................... 10.00 ^\ <br /> Sanitary .................................. 20.00 <br /> i <br /> Well ......... .......................... 10.00 <br /> Septic Tankk .... 10.00 <br /> �✓ Privy ............. 5.00 <br /> r <br /> . .,'.............9............ .. ..... .... .... ' ....✓ (. . .��...... ...... .......... <br /> Si nature of w eF''rr A en D to oning Administrator <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 />