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L 7 I , f, f/ !,j"., <br /> Burnett County Office of Zoning Administrator N o -1 z <br /> 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT a 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, <br /> ' . <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- <br /> lations of the State of Wisconsin. 3 O <br /> nur oti .duhv . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> Owner of AgCent (pl7e4 print) Y r Contractor or Surveyor Cl. . . .4q .L. : . .J-.QW.0.. .�TUE: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . � iw .Y 1 <br /> Address .in S-S�b 6 Address 3Sr <br /> Gla. ??Y. .D. 8.3�. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> Phone Phone <br /> Plumber � . . Well Driller �W <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ddre. . . . . . . . . . . . . . . . . . . . . . . . <br /> . . . . . . . . . <br /> . O :" <br /> Address Ass o <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Phon . . . . . . . . . . . . . <br /> . . . . . . . . . <br /> . . . . . . . . . . <br /> o 4 ' <br /> Phone Phone <br /> l o <br /> T. o <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: -o <br /> ype of Construction No. Bathrooms . . . . . • o z -0 <br /> 0 <br /> 1. Work G.4�^'��Y. r. . . . . No. Bedrooms . . . . . . ° <br /> New Building . . . . . . Size . . . . . ft. x . . . . . . ft. Septic Tank Size Gals. <br /> Addition Height . . . . . Stories . . . . . . <br /> . . . . . <br /> Sanitary . . � Area . . . . . . . Stories <br /> . . . . . . 7a.Absorption Field Site: o <br /> Filling . . . . . . Soil Type . . . . . . . . . . . . . . . . . . �: 0 >' <br /> Moving . . . . . . 5. Permits Required Slope . . . . . . . . . . . . . . . . . . . . i <br /> Grading . . . . . . Subdivision , . , , . . Perc. Rate . . . . . . . . . . . . . . . . . <br /> Mobile Home . . . . . . Sanitary . .i/� Dry Well . . . . . . W <br /> Privy . . . . . ./ Building Seepage Trench . . . . . . fA <br /> l/ <br /> Well . . Well , [,�� Privy <br /> Subdivision Other (Specify) Seepage Bed <br /> Conditional <br /> 2. Classification Land Use L <br /> o n <br /> Zoning Dist. <br /> 6. Use (describe exact) <br /> 3. Lot Size home, motel,etc.) FOR COMMERCIAL USE ° <br /> ft. x . . . . ft. Plans Submitted. <br /> E: U . . .'fi sq. ft. Plans Approved <br />-------- ------ -- -------------------------------------------- <br /> — <br /> 0 f/ Fig. A. Location of proposed structures and <br /> existing structures, well, sewage sys- ��� .� <br /> tems, roads, etc., should be sketched n <br /> in Fig. A. Include road setback, side <br /> and back yard dimension and location <br /> SS I�yS �C4 and setback from all bodies of water. -- <br /> If property is located ata highway in- <br /> tersection, <br /> n-tersection, show the intersecting high- <br /> ways and the setbacks required along <br /> x them and at the intersection. <br /> iC <br /> S PERMIT FEES c �� <br /> Subdivision.....$25.00 + $2.00 per lot. <br /> Land Use................................. $10.00 <br /> Building................................... 10.00 <br /> Sanitary .................................. 20.00 <br /> Well ........................................ 10.00 <br /> Septic Tank 10.00 <br /> Privy ....................................... 5.00 <br /> ................................ ......�. ...... .....� .. ..:.. /.� �% -...........:. <br /> Signature f Owner or Agent �te I4oning Administrator <br /> j�' �j'/ i C - - <br /> Inspection Date . .-/..X...-o...0................... Inspector :-.` hfi'" r- <br />