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Burnett Co ty �rr� Office of Zoning Administrator <br /> W. CD O C <br /> PLICATION FOR SANITARY LAND USE BUILDING PERMIT 3. <br /> I <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, <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- <br /> lations of the tate of Wisconsin. `� a v <br /> C <br /> CD <br /> C.. r+ < <br /> ;epp <br /> .. . . . . . . . . . . . . . . . . . _Owner o Agen (pleaint) Co ractor or Surve or N `� <br /> y - <br /> Address Address <br /> Q <br /> CD <br /> 3. . . . . . . . . . . . . . . . . . . .. . . . . '. . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> Phone Phone <br /> r4eL <br /> Plumber :- <br /> W I14-9"r ,. <br /> Address Address �� G) J <br /> .. n O <br /> . . . . . <br /> . . +647. . . . . . . . . . . . . . . . <br /> Phone Phone - CD �, r <br /> 0 ,� o <br /> O ,..� <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: _0 <br /> Ty Constructionr-+ <br /> � <br /> z <br /> No. Bathrooms • • • • o <br /> 1. Work '.': ' ?. ,.� . . . No. Bedrooms . . . . ° CD <br /> New Building . . ''`: . Size ft. x ft. Septic Tank Size Gals. <br /> Addition Height . . . . . Stories . . . . . . <br /> Sanitary . . . . Area . . . . . . . . . . . . . . . . . . . 7a.Absorption Field Site: ' <br /> Filling . . . . . . Soil Type . . . . . . . . . . . . . . . . . . : O •� <br /> � A <br /> Moving . . . . . . 5. Permits Required Slope . . . . . . . . . . . . . . . . . . . . <br /> Grading . . . . . . Subdivision . . , , , Perc. Rate . . . . . . . . . . . . . . . . . <br /> Mobile Home . . . . . . Sanitary Dry Well m : -.4 <br /> CD <br /> Privy . . . . . . wr,. Building •(�/' Seepage Trench C° <br /> Well . . Well Privy . . . <br /> Subdivision . . . . . . Other (Specify) . . . • • • Seepage Bed t, ',k ,�j ;C/'► <br /> Conditional . . . . . . Cn U <br /> 2. Classification Land Use . . . . . . � . <br /> Zoning Dist. . . c o <br /> 6. Use (describe exactly 1-- fam�.. <br /> 3. Lot Size home, motel, etc.) FOR COMMERCIAL USE <br /> . .j�Q. . . . ft. x 10 ft.ft. Plans Submitted . . . . . . ' <br /> . . . . . . . . sq. ft. Plans Approved . . . . . . •,%s <br />------------------------------------------ ------------------------- <br /> Fig. A. V <br /> Location of proposed structures and _ <br /> f existing structures, well, sewage sys- o <br /> !� tem s, roads, etc., should be sketched . .•. <br /> ` *7 tn <br /> in Fig. A. Include road setback, side ' tn <br /> and back yard dimension and location ` <br /> and setback from all bodies of water. <br /> 3 If property is located at a highway in- <br /> tersection, show the intersecting high- <br /> . <br /> ways and the setbacks required along <br /> them and at the intersection. <br /> 16 PERMIT FEES f <br /> Subdivision..... $25.00 + $2.00 per lot. CD <br /> Land Use........ .......... $10.00 •� - '� <br /> ��j B ....................... . 10.00 <br />