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Burnett County Office of Zoning Administrator �� 0 z <br /> D m a o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3" <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a '" o <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, F C <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- 0- <br /> lations of the State of Wisconsin. — O <br /> n <br /> Owner or Agent (please print) Contractor or Surveyor N <br /> 3v3z ��zx�,�w <br /> /3 14-P <br /> Address . . . . <br /> a N <br /> Address . . . . � � � � <br /> Phone <br /> Plumber . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> pp � � WeII Driller <br /> 7- <br /> Address \\t \ o y� <br /> Address � � � � � � � � � <br /> ba y - z7 // <br /> 0 <br /> Phone . . . .Phone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> 0 <br /> r <br /> n o <br /> DESCRIPTION 4. Building Details 0 <br /> 7. Sanitary Facilities: -o <br /> Type of Construction No. Bathrooms Z Z o <br /> 1. Work i1jfsy No. Bedrooms . . 1 ° p m <br /> New Building Size . . . . . ft. x . . . . . . ft. Septic Tank Size Gals. 7.5-1. <br /> Addition Height . . . . . Stories . . . . . . <br /> Sanitary .4: . . . Area . . . . . . . . . . . . . . . . . . . 7a.Absorption Fiel�4ite: <br /> Filling . . . . , . Soil Type . . . >04vv . . . 0 i <br /> 0 <br /> Moving . . . . . . 5. Permits Required Slope . . . . . <br /> Grading . . . . . . Subdivision . . . . . . Perc. Rate . �. ';'3, , , . . . . <br /> Mobile Home Sanitary , , , . .-. Dry Well m m <br /> Priv Building . . . . , . Seepage Trench m <br /> . . . . . . <br /> Well . . . . . . Well Privy <br /> . . . . . �. <br /> Subdivision . . . . . . Other (Specify) Seepage Bed <br /> Conditional o <br /> 2. Classification Land Use m <br /> Zoning Dist. . . . . . . n a o <br /> 6. Use (describe exactv,1 -fam <br /> or <br /> 3. Lot Size / fotel, etc.) FOR COMMERCIAL USE .J o <br /> . . . . ft. x �Y Vit. . . ft. Plans Submitted o <br /> . . . . . . . . . . . . . . . . . . sq. ft. Plans Approved <br />----------------------Fig. A. `� �✓ i r)J <br /> Location of proposed structures and <br /> existing structures, well, sewage sys- iJ o <br /> tems, roads, etc., should be sketched ' F <br /> _ in Fig. A. Include road setback, side ', : i5 <br /> X�p n/ and back yard dimension and location <br /> C•+ y�/�71- and setback from all bodies of water. <br /> �1 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 intersection. ! <br /> PERMIT FEES <br /> Subdivision . . . . . . . . . $15.00 <br /> Land Use . . . . . . . . . . . 1.00 <br /> Building . . . . 5.00 ✓: <br /> t C Sanitary 10.00 <br /> Well . . . . . . . . . . . 5.00 , <br /> Septic Tank . . . . . . . <br /> 10.00 <br /> Combination Building, Sanitary � <br /> y and Well . . . . . . . . 15.00 <br /> 7� Privy . . . . . . . . . . . . 5.00 <br /> a <br /> ... . ... lU .. .. � .. ..... j� !`.............................. <br /> Signature of Owner or Agent Dat � ZoninKdmin ist rator <br /> C 23 � <br /> Inspection Date i.,......:............7.."/................ Inspector ..�N'.L.?. <br /> !! RemarksG:/.J7 iC-d C.r ....,. . .... . .. . ..... .... . �-- ... ... ... <br /> i� �-� l�'7G � LLGLIc/. .. ...... <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 he made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />