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Burnett County Office of Zoning Administrator N ° o z <br /> m m y ° O <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT a 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 N <br /> Sanitation.Code, and with all other applicable County Ordinances and the laws and regu- v <br /> lations of the State of Wisconsin. a U <br /> 3 <br /> 1y(ant.t.CPr. .T: . .ME �LFn/. . . . . . . . .(''t`leNtc } T . . . L—_ae . . = <br /> Owner or Agent (please print) Contractor or Surveyor C <br /> NN <br /> V►1fr.N. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> : <br /> a <br /> 1 <br /> Address 1J`J�-�� Address <br /> +� <br /> Phone Phone ' <br /> .�. t�R.o� �r. : ,�s.•. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> : r <br /> Plumber Well Driller <br /> . . . . . . . . • . . . . . . . . . . A. . . .ddre.ss. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . � <br /> Address � � - � � � � � � � <br /> n O <br /> 0 < <br /> O <br /> Phone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Phone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ° <br /> r <br /> o <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: <br /> Type of Construction No. Bathrooms . . . . . . o Z °o <br /> 1. Work No. Bedrooms <br /> New Building . .x.44 . Sizeft. x . .3 a ft. Septic Tank Size Gals. .'.JCC � .� <br /> Addition Height . . Stories . .t! . . . <br /> 44 <br /> Sanitary . . .X. . Area 4 4 4 4 . . . 7�g 4 4 4 4 . . 7a.Absorption Field Site: :y :ltl r- <br /> Filling . . . . . . Soil Type . . . . . . . .54.h1:> o <br /> Moving . . . . . . 5. Permits Required Slope Q. . . . . . . . <br /> Grading . . . . . . Subdivision . . . . . . Perc. Rate . . . . . . . . .5- - - - - �� '• '• �1 <br /> Mobile Home . . . . . Sanitary , , .,', Dry Well . . . . . . ?' <br /> Privy . . Building „x „ Seepage Trench 4444 . . <br /> Well . . x. . Well . .x„ Privy <br /> Subdivision . . . . . . Other (Specify) . . . . . . Seepage Bed <br /> ConditionalCn <br /> 2. Classification p Land Use . . . . . . Q <br /> Zoning Dist. /J.R:�i . a o' <br /> (f 6. Use (describe exactly, 1 - fam. ;�� Z, <br /> 3. Lot Sizeome motel,etc.) FOR COMMERCIAL USE L' <br /> .13W4 . . ft. x .`-?.aQ ft. Plans Submitted . . . . . . <br /> . . . . . . . .� . . . . sq. ft. R9iN Plans Approved <br /> { ;A <br />----------------------------------------- ------------------- <br /> Fig. A. <br /> 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 <br /> and setback from all bodies of water. fV�S <br /> If property is located at a highway in- <br /> tersection, show the intersecting high- <br /> ��� zv-(,� ways and the setbacks required along <br /> them and at the intersection. <br /> iN <br /> PERMIT FEES <br /> Subdivision..... $25.00 + $2.00 per lot. ;� <br /> L se.........4.44..................4. $10.00 <br /> uildin 4444 10.00 i <br /> anitar ..... 35.00 /u1 <br /> e ..........4......................... 10.00 <br /> Privy ....................................... <br /> .L SS Uo <br /> ..:......." .....4 .:. ................................... <br /> Signature of Ownerc Date`1171 <br /> Zoning Administrator <br /> / <br /> Inspection Date ......... <br /> .�...i? y.:- .................. Inspector rrT!?>E;?;z7../....i ............................................... <br /> Remarks .. ............................................ <br /> ?.1rr -�4.--J.y1..� �".4-.7.................4_..............4.............4.4..............4....................4.....4........4....4...4....4........4...........4..4.. <br /> ............ 4.........................................................................................................................................................4....................... <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 />