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cl ) Wry <br /> Burnett County Office of Zoning Administrator N M O --1 Z <br /> m m 0 0 <br /> • APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT �. 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a - 0 N <br /> Permit for the work described and located as shown herein. The undersigned agrees that all H <br /> work shall be done in accordance with the requirements of the County Zoning Ordinance, <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- <br /> lations of the State of Wisconsi . °' O <br /> . . . <br /> f?4-. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 <br /> Owner or Agent (please print) S�/�J/�/J Contractor or Surveyor <br /> Address Address <br /> m <br /> Phone Phone <br /> tt � <br /> PlumberWell Driller <br /> O <br /> Address Address 0 o <br /> .& 5s-3.7. YO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A <br /> Phone Phone r 0 0 <br /> E o <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: <br /> Type of Construction No. Bathrooms . . . . . . Z z 0 <br /> 1. Work . . . . . . No. Bedrooms . . . . . . <br /> New Building . . . . . . Size . . . . . ft. x . . . . . . ft. Septic Tank Size Gals. <br /> Addition . . . . Height . . . . . Stories . . . . 7a.Absorption Fiel ite: <br /> � <br /> Sanitary Area . . . . . . . . . . . . . . . . . . . Y <br /> Filling . . . . . . Soil Type . . . .+� w <br /> Moving . . . . . . 5. Permits Required Slope , <br /> Grading . . . . . . Subdivision . . . . . . Perc. Rate <br /> Mobile Home . . . . . . Sanitary Dry Well �^ <br /> . . . . . . Seepage Trench . . . . . . <br /> Priv <br /> y Building . . . ivy r <br /> P <br /> Well . . . . . . Well . . . . . . . . o <br /> k. . . c :� <br /> Subdivision . . . . . . Other (Specify) . . . . . . Seepage Bed cn <br /> c� Conditional . . . . . . � c <br /> 2. Classification Zp�1t�Land Use . . . . . . - <br /> iU- a o <br /> Zoning Dist. V N <br /> Use (describe exactly, 1 -fam. <br /> • o <br /> 3. Lot 5ize home, motel,etc.) FOR COMMERCIAL USE 0 <br /> . !'C. ft. x .or. . . . ft. Plans Submitted . . . . . . <br /> sq. ft. Plans Approved . . . . . . jr; <br /> r <br /> ----------------------------------------- ---- <br /> -------------- --------------- -----9------------ '' i <br /> Fig. A. Location of proposed structures and <br /> existing structures, well, sewage sys- <br /> tems, roads, etc., should be sketched <br /> in Fig. A. Include road setback, side ) ---� <br /> and back yard dimension and location '0 <br /> and setback from all bodies of water, i f/=t <br /> If property is located at a highway in- i <br /> tersection, show the intersecting high- <br /> ways and the setbacks required along <br /> them and at the intersection. <br /> fkryS v ( PERMIT FEES <br /> Subdivision..... $25.00 + $2.00 per lot. � <br /> !i• Land Use................................. $10.00 <br /> Building................................... 10.00 <br /> I Sanitary .................................. 20.00 . <br /> Well ........................................ 10.00 <br /> S Septic Tank ............................ - <br /> Privy ....................................... 5.00 <br /> 32 � <br /> ................... .... �..-.. � .-Z.9 ........ ....��. ... r ................... <br /> "' "' Date Zoni ministrator <br /> Signat re of Owner or gent <br /> Inspection Date ......y,/ .5��f� Inspector ._ . .... .. .!�l�L" 'f. ....................................................... <br /> Remarks ....�� ..2 ...C/J/��i. ...................................................................................................................... <br /> .........................../�s/ 1�... ....!s.-!3 /G/............................................................................................................ <br /> ............................................................................................................................................................................ <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 />