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Burnett County Office of Zoning Administrator N � o --1 z <br /> W o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <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, F <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- <br /> lations of the State of Wisconsin. <br /> 3 o- <br /> d <br /> O <br /> ?o.., Ald . . Q . . .P.0.ls . . . . . . . . . . 3 F . . Bui .l.d.�.r.s.� .Lnc... . . . . , <br /> Owner or Agent (pie e print) Conhactor or Surveyor N <br /> Star- KOu.�C <br /> Web <br /> Aet-. .W,s. - . s-t8.9.3. . . . . . . . 5 � r^ � S`f.9oJ. . . . . <br /> Address Ad FJ ress o_ <br /> 1/�'Z15). . 63.5. x-.$.2.1.`.,1. . . . . . . . : . . . . Or 15). . 6. 3 S. -.8.3.'.`}.5. . . . . . . . . . . . <br /> Phone rr Phone ro\ <br /> . . . . . . . . . . 9 f� �C.Y �e.l.o�. .WE 1l. .fJr.i.i) rnSo <br /> Plumber Well DrLI JV \� <br /> f3o 268 W F 5 <br /> Addressl.,. N�t� S,�d w l... . . . . . . . . . . . . . . mss: <br /> Address Addresj Z \ G) <br /> 0 <br /> . . . . . . . . . . . .(7.1.r?.� . El `f '. aI.7.6. . . . . . . . . . . . ° <br /> Phone Phone ; 0 <br /> n o <br /> � o <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: a <br /> Type ofConstructi n No. Bathrooms <br /> 1. Work . . .IF.i . NO.C (W. .o.o44) No. Bedrooms ° <br /> New Building . . Size 'L4. ft. x . 36.. , ft. Septic Tank Size Gals. 1.40011 <br /> Addition . . . ./ Height . ). . . Stories .0 Ent- <br /> Sanitary . .1/. . Area . J516.4. .Sy+ � 7a.Abso4ption Field Site: <br /> Filling . . . . . . _.-_ Soil Type . . . . .00 o <br /> Moving . . . . . . 5. Permits Required Slope . . . . . . . . <br /> y .� <br /> Grading . . . . . . Subdivision Pere. Rate . . . . . . . . . . . . . . . . . ' <br /> Mobile Home Sanitary �j . Dry Well <br /> Privy . . Building ,0yyl101' Seepage Trench . . . . . . <br /> Well Well . , �/ . Privy <br /> Subdivision . . . . . . Other (Specify) . . . . . . Seepage Bed // v\ <br /> Conditional . . . . . . `0' <br /> 2. Classification Land Use . . . . . . <br /> Zoning Dist. ° <br /> //^ f 6. Use (describe exactly <br /> 3. Lot Size l / home, mote+-eetH FOR COMMERCIAL USE ° <br /> . °32.5. . . ft. x 6.Q . . ft. Plans Submitted . . . . . . N <br /> . . . .L.I. 4/.5.00. . sq. ft. Plans Approved . . . . . . <br />------------------------------------------ ------------------------- <br /> Fig. A. Location of proposed structures and \' <br /> � existing structures, well, sewage i l ° <br /> terns, roads, etc., should be sketched + � <br /> H <br /> in Fig. A. Include road setback, side s <br /> and back yard dimension and location <br /> and setback from all bodies of water. <br /> If property is located at a highway init <br /> - <br /> _5 tersection, show the intersecting high- <br /> i la ways and the setbacks required along <br /> T $ them and at the intersection. <br /> 0' y PERMIT FEES <br /> Ati� 7y Subdivision..... $25.00 + $2.00 per lot. <br /> NJ7q Vill +a 1ryf ,�. Land Use................................. $10.00 r :\ <br /> O Building10.00 r <br /> Q O ................................... <br /> Sa+t+xacl�.................................. 2 0.0 0 <br /> t^ ........................................ <br /> 10.00 <br /> f Scny,?ir•. Tank ............................ .19:80Q��_l <br /> C I +O� PrivyO <br /> ....................................... 5.0 <br /> 460 7 / <br /> �. <br /> ..........K.C�.O'1'.,..fJXwt.L.....LL.. . .!- .... ./!/ .. V....... .. .. .... . .... . .. . . ....... <br /> Signature of Owner or Agent to / Zoninnin is t r <br /> InspectionDate ................................................ Inspector ................................................................................................ <br /> ........ Remarks ................................................................ .. ............ ............ ��r� .... .... .. <br /> Q.... �� ...... .......................... ................................................... <br /> NOTE: A reliminary site e on must be made a site ap�granted on all structures involving sanitary facilities <br /> before construction can be in. In the case of sewers 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 />