2013/09/17 - SANITARY - SAN - Other

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Burnett County Office of Zoning Adrninistratcirf t APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 9. 3 TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a "' o Permit for the work described and located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the County Zoning Ordinance, s Sanitation Code, and with'all other applicable County Ordinances and the laws and regu- lations of thee—State of Wisconsin. 3 c _ (� O Ft r. /, . . P.'r. . . .L�.Mq (SO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Owner or Ayent (please print) ntractor or Surveyor :p ' Address Address Phone Phone ,n Plumber � � � � � � � � � � � � � � Well Driller Address Address O I n o J o va Phone Phone � DESCRIPTION 4. Building Details 7. Sanitary Facilities: o 'o ' Type of Construction . . . . . .No. Bathroomso 9° e 1. Work �f+.. . . . . . . . . . . . . . . . . . . . No. Bedrooms . . . .. P m New Building Size . . . ft. x . . . . . . ft. Septic Tank Size Gals. I.A. OF.) .� Addition . . . . eight . . . . . Stories . . . . .. . .. . . . Sanitary . .G.,/ Area 7a.Absorpti°n Field Site: Filling Soil Type . . . . . . . . . . . . . . . . . . Moving . . . . . . 5. Permits Required Slope . . . . . . . . . . . . . . . . . . . . Grading . . . . . . Subdivision . . . . . . Pere. Rate Mobile Home . . . . . . Sanitary Dry Well Privy . . . . . . Build Ing . . . . . . Seepage Trench . . . . . . 'r i° i 111 Well . . . . . . Well , , , , ,, Privy Subdivision . ; . . . . Other (Specify) . . . . . . Seepage Bed Conditional . . . . . . - N A c 2. Classification Land Use . . . . . . n P. Zoning Dist. . . . . . . Uj !ll�� o 6. Use (describe exactly, 1 -fam. 1 Lot Size home, motel,etc.) FOR COMMERCIAL USE 0 . . . . . . . . . ft. x . . . . . . . . ft. Plans Submitted .. . . . . . s-et.'.G-!-' —, sq. ft. Plans Approved Pp V 1 ------------------------------------------------------------------ Fig. A. Location of proposed structures and '3 1 existing structures, well, sewage sys. ° c ? terns, roads, etcshould sketched i in Fig. A. Include e road sett ts back, side and back yard dimension and location : 'o and setback from all bodies of water. bl If property is located at a highway in- \ 1 [ersection, show the intersecting high- ;(1 1 ways and the setbacks required along Y them and at the intersection. NQ PERMIT FEES Subdivision $15.00 Land Use . . . . . . . . . . . 1.00 Building Sanitary Q:90� Well5-09- Septic Tank . . . . . CEDE, Combination Building, Sanitary and Well . . . . . . . . 15.00 Privy . . . . . . . . . . . . 5.00 E �c�.� :7z -lam , _ . Si nature of Owner or A ent Date Z nin Ad istralor Inspection Date ..(„J.a .... J,:..�.9.7.7........ ....Inspector ............... 4�✓s......Get"'4'.vcdr ................. Remarks ................................... ...... ...... J//// .. ...... ........ ......, .... NOTE: A preliminary siteemion be made and site approval granted on all structures involving sanitary facilities before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to this application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build! ing until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here with is found to exist. Changes in plans or specifications shall not be made without approval of the Zoning Administralori SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED.