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Burnett County Office of Zoning Administrator Y - r'�' <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT a 3 f <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application fora � '" ° <br /> Permit for the work described and located as shown herein. The undersigned agrees that all v �� <br /> work shall be done in accordance with the requirements of the County Zoning Ordinance, <br /> m <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- _ <br /> lations of the State of Wisconsin. 3 �:0 ♦1 <br /> N�t�N k' `o NJ ~ - <br /> €moo <br /> Owner or Agent (please print) Contractor or Surveyor <br /> : r <br /> c <br /> Address Address n kjl :7 G <br /> . . . . . . . . . . . . . . . . <br /> Phone Ph. . one. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> . . . . . . . . . . . . . . .W.ell. .Drillerw. . OtiF,e. . . . . . . . . . . . . . . . . . . . V� O4 <br /> P1-kr •'l <br /> V 0 <br /> ocA - 4 <br /> Address Address :r m L1 <br /> o C'! <br /> o <br /> Phone Phone 0 <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: -O <br /> Type of Construction No. Bathrooms . / . o Z �° <br /> 1. Work NWf.Fe4M.4. . . . . . . No. Bedrooms <br /> New Building . .h . . Size .a6. ft. x . 35r, ft. Septic Tank Size Gals. . :750 .� <br /> Addition Height Stories . ./. . . . . . . . . . � .0 <br /> Sanitary . . . . Area . . .$'ys/. .,0. . . . . . . 7a.Absorption Field Site: O ' <br /> Filling . . . . . . Soil Type F Pe �5ah� <br /> . . .!J <br /> Moving . . . . . . 5. Permits Required Slope . . . . <br /> Grading . . . . . . Subdivision . . Perc. Rate . . . . . . . . . . . . . . . . . :'s <br /> Mobile Home . . . . . . Sanitary . . . Dry Well . . . . . . ,", <br /> Privy . . Building . ..v( , . Seepage Trench . . . . . . J <br /> Well . .X . . well „h, Privy ,p I 11 <br /> Subdivision . . . . . . Other (Specify) . . . . . . Seepage Bed A.X?7 _No <br /> Conditional <br /> c � <br /> 2. Classification Ad) Land Use <br /> Zoning Dist. . . . . . . o <br /> 6. Use (describe exactly, 1 -fam. <br /> _. <br /> 3. Lot Size home, motel,etc.) FOR COMMERCIAL USE ° <br /> 37� . 17.3. .ft. x . $. . ft. CABIO Plans Submitted . . . . . . jtA <br /> . . . . . . . . . . . . . . . . . . sq. ft. Plans Approved . . . . . .------------------------------------------------------------- <br /> Fig. Location of proposed structures and <br /> existing structures, well, sewage sys- 0 <br /> ko tems, roads, etc., should be sketched <br /> in Fig. A. Include road setback, side =r <br /> 37 and back yard dimension and location n y a <br /> and setback from all bodies of water. b <br /> wait If property is located at a highway in- � <br /> \rY ( e tersection, show the intersecting high- <br /> ways and the setbacks required along T <br /> 0 ly them and at the intersection. <br /> PERMIT FEES <br /> SQ.w <br /> fe Subdivision . . . . . . . . . $15.00 � ���10 <br /> SYsfez~t Land Use . . . . . . . . . . . 1.00 <br /> Building . . . . . . 5.00 <br /> Oe Sanitary . . . . . . . . . . . 10.00 'v <br /> M Well .ja i I <br /> \ . . . . . . . . . . . - IF <br /> Septic Tank . . . . . . . P.00 C _ <br /> Combination Building, Sanitary �. <br /> and Well . . . . . . . . 15.00 <br /> 173/ Privy . . . . . . . . . . . . 5.00 <br /> 7" Signa. : :. ............. . . . . ............... .. //�p�...,�. .prat � A/,gt. ....................Sige of Owner or Agent �✓ D �Admi, <br /> QQ �' , I I <br /> Inspection Date .. ........��. �.". .� Inspector ..:f.-Z.' 7=z�GY-�.l..lC.y. .... <br /> ............................ <br /> Remarks 5.r .:.... .Zr� .�.�..f...2�i.� .1/ �i .................. ....................................... <br /> .................................................................................................................................................................................I.............. <br /> ..........................................................................................................................................................................................I..... <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 />