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Burnett County Office of Zoning Administrator <br /> '1-Mv 0 z <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hemby makes application for a o :per <br /> Permit for the work described and located as shown herein. The undersigned agrees that all H ;� <br /> woKk shall be done in accordance with the requirements of the County Zoning Ordinance, x m <br /> ° <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- "a <br /> m <br /> lations f the State of isconsin. a i+ <br /> O <br /> ��. A �.� 5 . . . . .Q.�.S.�. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> Owner or Agent (please print) Contractor or Surveyor <br /> . . r o /6 .. �A/ea 'L) <br /> A <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . c o. :� <br /> Address Address. . . . . . 0. ?� <br /> d.s.s e ° . . . . h . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . — <br /> d <br /> Phone Phone <br /> ba <br /> Plumber Well Driller <br /> Address Address p o :m <br /> <' <br /> :\ �0 3 : <br /> Phone Phone o C <br /> m O <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: z z o <br /> Type of Co stnfct' No. Bathrooms <br /> 0 <br /> 1. Work . . . . . . . . . . . . No. Bedrooms • .�-� � o � <br /> New Building . . . . . . Size . . . . . ft. x . . . . . . ft. Septic Tank Size Gals. . . . . . . <br /> Addition Height . . . . . Stories . . . . . . . . . . . . <br /> SanitaryArea 7a.Absorption Field Site- � :1j ! <br /> Soil Type . . . :� :1— o <br /> Filling . . . . . . 4 v <br /> Moving . . . . . . 5. Permits Required Slope . . . . . . . . . . . . . ;. <br /> Grading . . . . . . Subdivision . • . . . . Perc. Rate . . . . . . . . <br /> m T <br /> Dr <br /> Mobile Home . . . . . . Sanitary L./ y Well • • • � � <br /> Privy . . . . . . Building • • • • • • Seepage Trench . . . . m f <br /> Well . . . . . . Well Privy 4 <br /> fo <br /> Subdivision . . . . . . Other (Specify) . . . . . . Seepage Bed o G <br /> Conditional . . . . . . o `o �c <br /> 2. Classification �pp Land Use . . . . . . :c a `. <br /> Zoning Dist. 0 <br /> 6. Use (describe exact , 1 -fam. f <br /> 3. Lo Size home, motel,etc.) FOR COMMERCIAL USE a o F <br /> o.v. .ft.x . . ... ft. Plans Submitted . . . . . . <br /> . . . . . . . . . sq.ft. Plans Approved . . . . . . <br /> ------------------- ---------------------------------- <br /> Fig. A. Location of proposed structures and <br /> existing structures, well, sewage sys- ' <br /> tems, roads, etc., should be sketched ^ <br /> in Fig. A. Include road setback, side ^ s <br /> and back yard dimension and location o <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 /> c , them and at the intersection. <br /> `JI PERMIT FEES <br /> Subdivision.....$25.00 + $2.00 per lot. <br /> Land Use................................. $10.00 <br /> Building................................... 10.00 _ZN <br /> anitar .................................. 35.00 <br /> Well ........................................ 10.00 <br /> Privy ....................................... 5.00 <br /> ... . . .............................. F./............... ............................................................ <br /> Signa re of Owner or Agent Date Zoning Administrator <br /> InspectionDate .............1.................................... Inspector ................................................................................................ <br /> Remarks ,, L !.. 4?�Y!!cr?.... ��. <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 />