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fn Infi <br /> Burnett unty /�G Office of Zoning Administrator O --1Z <br /> W o 0 <br /> iE <br /> PPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a 0 <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, M <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- <br /> lations of the State of Wisconsin. O <br /> 3 » :I <br /> SS . . . . . . . . . . . . .f. r!. .B,�S Cv�sr <br /> cOwner or Agent (please print) Contractor or Surveyor <br /> p m <br /> . . . . . . . . . . . .A . . . . . . . . . . . . . . . . . . � <br /> Address de <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> Phone Phone <br /> L S Ko .. . . .. J d ,C <br /> Plumber. . . . . . . . . . . . . . . . . . . . . . . . . . . . WeII.DritT . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> O <br /> l�J �.4r . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \ <br /> Address Address m <br /> o R <br /> Q . . <br /> V. �. . V.v . . V. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . �l <br /> Phone Phone " r- <br /> 0 <br /> o <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: � a <br /> Type o�000,truction No. Bathrooms o Z -°0 <br /> 1. Work . . . <br /> . .�: !�.E. . . . . No. Bedrooms <br /> New Building . . . Size . . . . . ft. x . . . . . . ft. Septic Tank Size Gals. 75-0 <br /> Addition . . Height . . . . . Stories . . . . . . . . . . . . <br /> Sanitary . . , . , . . . . . 7a.Absorption FieWS'tC� <br /> . .�f"'. . Area . . . . . . . . . 'SS <br /> Filling . . . . . . Soil Type . . . . . . . . . . o <br /> A <br /> Moving . . . . . . 5. Permits Required Slope . • ' �'�c "F') <br /> Grading . . . . . . Subdivision Perc. Rate . . . . . . /. . . . . . . <br /> Mobile Home . . . . . . Sanitary a!�. Dry Well . . . . . . <br /> Privy . . . Building Seepage Trench . . . . . . <br /> Well . . . . Well Privy . <br /> Subdivision . . . . . . Other (Specify) . . . . . . Seepage Bed � �•� '�\ ;_ <br /> Conditional . . . . . . m N <br /> 2. Classification Land Use . . . . . . � »_ <br /> Zoning Dist. Z, a <br /> 0 <br /> 6. Use (describe exact , 1 -fam <br /> 3. Lot Size home, motel,etc.) FOR COMMERCIAL USE <br /> /^fjy� . . ft. Plans Submitted <br /> l � S. sq. ft. Plans Approved -� <br /> / . . . --- <br /> Fig. A. Location of proposed structures and <br /> existing structures, well, sewage sys- ;-1 0 <br /> tems, roads, etc., should be sketched <br /> in Fig. A. Include road setback, side <br /> and back yard dimension and location <br /> and setback from all bodies of water. :h <br /> If property is located at a highway in- <br /> tersection, show the intersecting high- <br /> ways and the setbacks required along i <br /> them and at the intersection. <br /> PERMIT FEES <br /> Subdivision..... $25.00 + $2.00 per lot. `D <br /> Le................................. $10.00 <br /> 10.00 <br /> nit r ....7j.: .. -JMW i i <br /> ell .................................. .. 10.00 <br /> Septic Tank 10.00 <br /> Privy ....................................... 5.00 <br /> ........ ...................... �..C/ . ........ .. . . - . <br /> �//,O .... ..................... <br /> Si nature of Owner or A ent Date / 0n? dminisr <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 />