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Burnett County Office of Zoning Administrator - o --1 Z <br /> m 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a o �V <br /> Permit for the work described and located as shown herein. The undersigned agrees that all H y <br /> work shall be done in accordance with the requirements of the County Zoning Ordinance, pr m <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- _ 0. <br /> lations of the State of Wisconsin. a <br /> ` /� C :^ <br /> h . . . . . . . . F.'I. . !.L .!` F. 'W... . . . . . . . . " _s <br /> Owner or Agent (please print) Contractor or Surveyor <br /> ;A <br /> '�!... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> Address Address <br /> SS / Gt/t�ltiM !�!� +�.�. . . . . . . . . . Oi <br /> . . .�. t/. <br /> Phone (( Phone <br /> \� .n <br /> Plumber Well Driller `: <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ° <br /> Address Address <br /> o < F <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> Phone <br /> Phone _ <br /> 0 :b <br /> o <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: <br /> Type of Co st uctio / No. Bathrooms o z 00 <br /> �,f �d d No. Bedrooms <br /> 1. Work . . . . �. X. . ?. . . . . . . . . . . . <br /> New Building Size . . . . . ft. x . . . . . . ft. Septic Tank Size Gals. $-.L < <br /> . . . v <br /> Addition �� Height . . . . . Stories . . . . . . ; <br /> Sanitary . .':� Area 7a.Absorption Field Site- <br /> Sanitary <br /> Fillin Soil Type . . . . . a�.f.°JP.�. . K ° <br /> g <br /> Moving . . . . . . 5. Permits Required Slope . . . . . . . . . �1 <br /> Grading . . . . . Subdivision Perc. Rate . . . . . . . .7. . .!rn zr. <br /> Mobile Home . . . . . . Sanitary Dry Well <br /> Privy . . . . . . Building jj�/ Seepage Trench <br /> 6. <br /> Well . . . . . . Well Privy <br /> Subdivision . . . . . . Other (Specify) . . . . . . Seepage Bed .. . . <br /> Conditional . . . . . . N N <br /> 2. Classification Land Use : 1 <br /> Zoning Dist. <br /> 0 <br /> 6. Use (describe exactl <br /> home, motel,etc.) FOR COMMERCIAL USE ° <br /> 3. Lot Size : •, 3 <br /> ^ ft. x ft. Plans Submitted <br /> oS.l9J.0Q, . . . . sq. ft. Plans Approved . . . . . . <br /> -———————————————————————— --------- ------------------------- <br /> Fig. A. Location of proposed structures and <br /> existing structures, well, sewage sys- I 0 <br /> tems, roads, etc., should be sketched <br /> L c '� ♦ ( � in Fig. A. Include road setback, side <br /> and back yard dimension and location <br /> and setback from all bodies of water. <br /> If property is located at a highway in- W <br /> l ] <br /> �S D�� hd� tersection, show the intersecting high- ;off <br /> ,�P �n`J ways and the setbacks required along <br /> ,�Q�It Dptl 9s- them and at the intersection. <br /> L• PERMIT FEES <br /> r 8 J(?y-�-La<I I <br /> Subdivision..... $25.00 + $2.00 per lot. <br /> Ss' ter. • .. .. Land Use................................. $10.00 <br /> Building................................... 10.00 <br /> 1 y Sanitary .................................. 20.00 <br /> `d I, Well <br /> ........................................ 10.00 <br /> Septic Tank .........0...0.............. 10.00 <br /> Privy ....................................... 5.00 <br /> L� <br /> a <br /> .. �G...... GG�� .................... <br /> ....... . .. ..... .............. <br /> Signature��o Owner or Agent D e Zoning Administrator <br /> Inspection Date ..Cr...... ... ��.................. Inspector ..1��!?Y�tri, f. cf1« .. . <br /> RemarksG�.� . rGL. lr7�� '.... . �... r+Zz.. G r .. .............................0............... <br /> ................................................................................................................................................................................................ <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 />