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S <br /> •� i. Office of Zoning Adrninist(a ort �� i 1 0 1 Z — <br /> ��� � COURtyz o 0 <br /> Burnet yp. A f <br /> 'AP <br /> PLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3_ o <br /> TO THE ZONING ADWNISTRATOR: The undersigned hereby makes application for a <br /> Permit for the work described and bcated as shown herein. The undersigned agrees that all a <br /> work shall be done in acco,dan",wilh 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. <br /> :R A <br /> I erorgc�D s ..Pr T. <br /> w . . . . . . . . . . . . . — . . . . . . . . . . . . . . . . . . q <br /> Owner Or Agent (plea. se pant) Contractor or Syurweyor ;� <br /> (J C • v,.,, \ 4 v�!15. O �P . . 1".IN4. . G e .� <br /> AtlAddress 'c <br /> W ess <br /> To . c oa <br /> �. t2 -.�'. . . . .3 . . . <br /> i <br /> i Phone <br /> Plumber. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Well Driller. ... <br /> J tJ <br /> Address Address 'i' <br /> is o <br /> f - <br /> O <br /> Phone Phone - - :� � •" .°r. <br /> o' <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: <br /> Type Af Construction No. Bathrooms oZ <br /> . a <br /> 1. Work s/ . . . 7VRL. _,c. 2 <br /> . r. .. . . . . . No. Bedrooms - . . P <br /> New Building . X. . Size 25( . ft. x . .31- ft. Septic Tank Size Gals. <br /> Addition . . Height . sylas . . . <br /> . . . . . . CfI . . . <br /> Sanitary . .�. . Area . . ` 7a.Absorp[ipn Field S�p: <br /> 4G4. . . . . . . . . . . . . l Y <br /> Filling . . . . . Soil Type <br /> Moving . . . 5. Permits Required Slope . . . . . <br /> Grading . . . . . . Subdivision . , , , , Pere. Rate . .G .(`.i . . . . . . . . . . <br /> Mobile Home Sanitary „. K. .'. Dry Well . . . . . .� s <br /> Privy . . Building Y Seepage Trench . . . . Irl <br /> Well . .'r . . Well a.�. . . <br /> Subdivision . . . . . . Other (Specify) . . . . . . Seepage Bed <br /> n Conditional m A I <br /> 2. Classification u Land Use . . . . . . e, \ Z <br /> Zoning Dist. 4l L ° <br /> Pu <br /> 56 Use describe exactly, tam <br /> 3. Lot Size om moto'el,etc.) FOR COMMERCIAL USE :� <br /> p1 <br /> . . . . . . . . .4. x . . . . . . . . ft Plans Submitted . . . . . . 7') <br /> . . .2Qf.0I. . . . . sq.it. Plans Approved . . . . . . {� <br /> i <br /> __________________________________________________ _P____ ______ <br /> P jQ <br /> Fig. A. Location of proposed structures and _ <br /> existing structures, well, sewage Sys- it c <br /> zt )ems, roads, etc., should be sketched W E <br /> in Fig. A. Include road setback, side is Y.z <br /> and back yard dimension and location, <br /> and setback from all bodies of water. zf \T <br /> If property is located at a highway in ?� <br /> tersection, show the intersecting high- ?b <br /> ways and the setbacks required along ?� <br /> them and at the intersection. <br /> PERMIT FEES �,'�i4 <br /> Subdivision.....$25.00 + $2.00per ;of. hr, . <br /> Land Use........................... ..... S10.00 :`0 i <br /> Building............................... <br /> Sanitary ................................ � 4`7� <br /> Well ........................................ ' <br /> .G <br /> Privy ....................................... 5.00 <br /> �J� p � 1•;+li <br /> $ignatu re of Owner o Agent .% Datr✓ Zoning Administrator <br /> Inspection Date ................................................ Inspector ........ ..._................................................ ............ ...... <br /> .....' <br /> Remarks '•' - a <br /> ............................................................_........................_........_.................................................. <br /> it <br /> .................._............................................................ ....... ... ............ \: ` R <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary, fat <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attac <br /> this application before a permit will be issued. Do not purchase or install,a septic tank, do any plumbing or start any <br /> ing until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveye <br /> with is found to exist. Changes in plans or specifications shall not be made without approval of the Zoning Admin <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AANND.APPROVEC <br />