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Burnett'County Office of Zoning Administrator ,n v o ti z� <br /> 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT `. 3 ,(�` <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a <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, x a <br /> Sanitation Code, and with .1I other applicable County Ordinances and the laws and regu- <br /> lations of the State of Wisconsin. 3 c O k <br /> Fred Seifert. . . . . . . . . . . . . . . . . . . . _ — � R1 A I <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xS <br /> Owner or Agent (please print) Contractor or Surve or N <br /> Y <br /> Webster, WI 54893 Rt. 2 <br /> Address Address n � i <br /> 866-7267 <br /> Phone Phone , <br /> Donald Daniels <br /> Phil . . . . . . . . . . . . . . . . . . . . . . . . . . .v i <br /> Well Driller <br /> Siren, WI 54872 .� o <br /> Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Addresss/7. . . . . . . . . . . . . . . . . . . . . . . . . . . . . i _ a m <br /> 349-5364 or 463-2333 0 ✓ IV, b55(o��, <br /> 0 <br /> Phone Phone �10 � <br /> m o- <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: <br /> Type of Construction No. Bathrooms d 0 2 <br /> 1. Work . . . .. . . .. . . . . . . . . . . . . . . . No. Bedrooms . . . ° Wr <br /> New Building . . . . . . Size . . . . . ft. x .: . . . . it. Septic Tank Size Gals.,-PiJLG� <br /> Addition . . . . . . Height . . . . . Stories . . . . . .- v 1 <br /> Sanitary . X . . . Area . . . . . . . . . . .. . . . . . . . 7a.Absorption Field Site: <br /> Filling . . . . . . Soil Type . . . . . . . . . . . . . . . . . . c <br /> Moving . . . . . . 5. Permits Required Slope . . . . . . . . . Level. . . . . r <br /> Grading . . . . . . Subdivision Perc. Rate . . . . .3.1 -3 <br /> Mobile Home . . . . . . Sanitary X Dry Well <br /> Privy - . . . . . . Building . . . . . . Seepage Trench . . . . . . <br /> Well Well Privy . .. . . . u, <br /> o v <br /> Subdivision . . . . . . Other )Specify) . . . . . . Seepage Bed 18r05' o t A <br /> Conditional . . . . (� A <br /> 630 ag.ft. <br /> 2. Classification Land Use . . . . .. <br /> Zoning Dist. . . . . . . z o f <br /> 6. Use (describe exactly, 1 fare. Ov <br /> 3. Lot Size home, motel,etc.) FOR COMMERCIAL USE <br /> . . . <br /> 100. . . ft. x .(.200 . ft. Plans Submitted . . . . . . <br /> 20;000 , , , , sq. ft. 1 family home(exsisting)Plans Approved Gl <br /> Fig. A. Location of proposed structures and I <br /> r existing structures, well, sewage sys. <br /> tems, roads, etc., should be sketched y5j [U.1 <br /> in Fig. A. Include road setback, side 1 <br /> and back yard dimension and location W a <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 /> them and at the intersectionM{ <br /> J J <br /> PERMIT FEES <br /> JC Subdivision . Si6 BB <br /> Land Use . _ _ . . _ 10.00 <br /> Build inq 10 <br /> Sanitary . . . . . . .ZQi6:OP <br /> Well . .!D -5.89 <br /> Septic Tank 10.00 <br /> Combination Building, Sanitary <br /> and Well . . . . . . . .:6rA0 <br /> Privy . . . . . . . . . . . . 5.00 <br /> ' Si nature o/f�Owner or A ent at o dm mistrator <br /> Inspection Date ....7..'-..:.�. ..._7. .......... Inspem <br /> ......................... <br /> �] ...... .. ..... . . ..... ... .. <br /> Remarks .... f]�� .G.d... / ........................._................... <br /> . ..................... <br /> ................................................................................................................................................................................................ <br /> 1 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 />