Laserfiche WebLink
Burnett county - --"--• Office OT Zoning Administrator <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT D, 3 <br /> �— <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereAy makes application fora <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 !09 <br /> Sanitation Code, and with all .,her applicable County Ordinances and the laws and regu. s ;� <br /> lations of the State of Wisconsin. 3 d O <br /> , . {{ a = f <br /> Owner or Agent (Please print) Contractor or $urveypr i� 'O �� <br /> 0 <br /> q/�� . . . . . . . . . . . . . . . . . . . . . <br /> ress ress Addres c <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . c :5 <br /> Add � Add <br /> ST �Migrt S. . . . . . . . . . . .�.( (� . . . . . .E. �.?.- . .7.7y. 3.�.� �.'. . . . . = ac <br /> Phone n '\ Phone - <br /> Plumber Well Driller <br /> Address Address �� o ip <br /> o ? <br /> Phone C ' Phone � r :� <br /> T o <br /> DESCRIPTION 4. BuildingDetails Facilities; <br /> 7. No Sanitary Facilities: ; <br /> Type of Coostr��coon No. Bathrooms o ° <br /> I. Work . . .,R.K.0$,(r 4.`. . . . . .. No. Bedrooms <br /> New Building . . . . . . Sire . . . . . ft. x . a. . . . ft. Septic Tank Size Gals. <br /> Addition Height . Stories . . . . . . 7SQO \' <br /> Sanitary Area . . . . . . . . . . . . . . . . . . . ]..Absorption Field Site: I r \ <br /> Filling . . . . . . Soil Type . . . . . . .J. .`!Vit. . . . . . . <br /> Moving . . . . . . 5. Permits Required Slope . . . . . . . . . . . . . . . . . . . . VQ <br /> Grading Subdivision <br /> Mottle Home Sanitary (/ Seepage <br /> Weil <br /> Prv Building Seepage <br /> ch / . .. ... .Well Well Y s <br /> Subdivii.n OtherSpecfyI ee a Bed <br /> ' <br /> Conditional . . . . . . .•3L . ` m m ) <br /> 2. Classification Land Use <br /> a 1 <br /> Zoning Dist. . . . . . . 1 a o + <br /> 6. Use (describe exactlyGm <br /> 3. Lot Size home,motel,eta) FOR COMMERCIAL USE <br /> o <br /> r <br /> . . it. x . . . . . . ft. Plans Submitted . . . . . . � i5L <br /> . A e sq. ft. Plans Approved <br /> Fig. A. T. F_ <br /> 7 Location of proposed structures and <br /> existing structures, well, sewage sys- <br /> tems, roads, eta, should be sketched <br /> in Fig. A. Include road setback, side 's <br /> and back t ' <br /> yard dimension and location <br /> and set <br /> 'y} back from all bodies of water. 5\1i <br /> �l 111 If property is located at a highway in <br /> IIe� tersection, show the intersecting high <br /> ways and the setbacks required along f <br /> 'D°' 1 Q �� them and at the intersection. <br /> P PERMIT FEES AQ <br /> - <br /> Subdivision 515.00 lig <br /> Land Use . 1.0073 <br /> Building <br /> Sanitary .00 <br /> Well . . . . . 5.00 <br /> -4 sj Septic Tank 10.00 ''t ! <br /> a Combination Building, Sanitar `� } <br /> and Well 15.00 ^al <br /> .........4..'...S.. Privy ...... ./... . •...N.. ."�.y.. . . . 5IL,.a0�0 <br /> ..t............... <br /> tD_te Z O. A ninlstrator*'�Nj.cair/a<:A.+:rl <br /> �+ <br /> _ // <br /> Inspection Date ..�.. TP......... Inspector/, r�Zr✓�� .. <br /> G / n r ` u <br /> R e re ar ks .....C.f.J7/..Y C;,%.{'.6v ..z. ' ...i�.l�.t.l�"(... <br /> ............................ .............................................................................................................................................................i <br /> d..Z?a4,7...................................................................................................................................... <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facil <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attachee <br /> thi< application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any bar <br /> ing until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed h� <br /> with is found to exist. Changes in plans or specifications shall not be made without approval of the Zoning Administra' <br /> SEWER <br />—__ SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. + <br />