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Burnett County Office of Zoning Administrator C 0 Z <br /> W ° ° <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application fora <br /> Permit for the work described and located as shown herein. The undersigned agrees that all n <br /> work shall be done in accordance with the requirements of the County Zoning Ordinance, x <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- _ ° :r <br /> lations of the State of Wisconsin. CCL <br /> ' p <br /> �q z _. ~ D <br /> � K. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .�x�. . . . 2 .�1 <br /> Owner or Agent (please print) Contractor or Surveyor N <br /> Address . . . . . . . . . . . . . 4-A <br /> Address a <br /> . . . . . . . . . . . . . . . . . <br /> Phone Phone <br /> Plumber Well Driller V <br /> D��/lyl- � Guy . . . . . . . . . . . . . . . . . . Y <br /> Address Address 0 n1 <br /> . 3 y . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . :r <br /> Phone Phone o <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: ° ~ <br /> Type-of Construction No. Bathrooms . • f. . . Zz ° <br /> 1. Work �l's..X�?� .(n L No. Bedrooms 3. • • ° l <br /> New Building . . .x. . Sizes ft. x . .T. //ft. Septic Tank Size Gals. %!`d <br /> Addition Height Stories . . .!. . . .5r '\ ' <br /> Sanitary . . . . . Area ���. . . . . . . . 7a.Absorption Field Site: o <br /> FillingSoil Type . . . . . .�,� . <br /> Sloe �r^ <br /> Moving . . . . . . 5. Permits Required p �BUO �k <br /> Grading . . . . . . Subdivision Perc. Rate . . . . . . . . . . .�. . . <br /> Mobile Home . . . . . . Sanitary • , �!(. . Dry Well . . . . . . <br /> Privy Building y. - Seepage Trench . . . . . . <br /> Well .X. . Well IN . fo <br /> Privy ` <br /> Subdivision Other (Specify) . . . . . . Seepage Bed s im <br /> Conditional . . . . . . <br /> � . <br /> 2. Classification Land Use . . . . . . <br /> Zoning Dist. (j a ° <br /> < _ <br /> 6. Use (describe exactly, -fam. o. <br /> 3. Lot Size hom , motel,etc.) FOR COMMERCIAL USE ;c r <br /> ft. x . . . . . . . . ft. Plans Submitted . . . . . . <br /> �-V <br /> 1 = <br /> �. ry-. . . sq. ft. Plans Approved . . . . . . : J <br /> ------------------------------------------------------------- <br /> ---- : <br /> Fig. A. 40a Location of proposed structures and <br /> existing structures, well, sewage sys- o <br /> 2 tems, roads, etc., should be sketched = <br /> in Fig. A. Include road setback, side I s <br /> l and back yard dimension and location <br /> r and setback from all bodies of water. <br /> l 78 If property is located at a highway in- <br /> lbJ�b AY tersection, show the intersecting high- <br /> ways and the setbacks required along <br /> them and at the intersection. <br /> 33o t � —moo • . <br /> Ply PERMIT FEES <br /> �8 Subdivision..... $25.00 + $2.00 per lot. m <br /> �o4Uta3 `f�to quzaS . Land Use................................. $10.00 <br /> y Building................................... 10.00 <br /> o 2U Sanitary .................................. 20.00 <br /> Well .......................................6 10.00 <br /> Septic Tank ............................ 10.00 <br /> Privy ....................................... 5.0/0 <br /> % S.ign'atureowne ge ..............c..... .- ./.... )./.,. t....................... <br /> Date -maor . <br /> Inspection Date ......//-/o, �....................... Inspector L r 1 .( <br /> �........................................................... <br /> Remarks ......W(V�... .. JCC-�It-NG................................................................................. <br /> ....... ij. ........................................................................................................................................................... <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 />