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Burnett County Office of Zoning Administrator O --1 Z <br /> a o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT °. 3 <br /> n - 0 <br /> 4� TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a <br /> Permit for the work described and located as shown herein. The undersigned agrees that all d <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 Wisconsin. a <br /> Owner or Agent (please print)[� Contractor or Surveyor r :� <br /> �? . . .�?C➢ Il .'�? .y' .l.l. �. . . . . . . . . . . . . a <br /> Ad�d+ress ( / Address <br /> �4.(.�� f. . .iM t�. . . . J.S.`0, L. . . . . . . . . . . . . . . . . . = 3 <br /> Phone Phone <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> Plumber z Well Driller <br /> 0 is <br /> . . . . . . . . . . . . . . . . . . . . . . . <br /> Address Address O ,\\\ 0 o <br /> . . . <br /> iT�.e . . . . . . . . . . . . .. <br /> o <br /> hr <br /> Phone Pone <br /> o <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: D <br /> Type of Construction No. Bathrooms o Z a . <br /> 1. Work / F�.4. ��'^."` . . . . . No. Bedrooms ' <br /> New Building . .(.!. Size Pg. .y. ft. x .-� nL. ft. Septic Tank Size Gals. . . . . . . < ' <br /> Addition . . . . . . Height . . . . . Stories . . . . . . :]TI <br /> Sanitary . . Area 7a.Absorption Field Site: 'W o <br /> Type <br /> Filling . . . . . . Soil T e -- �: <br /> Moving . . . . . . 5. Permits Required <br /> Slope \\\ <br /> Grading . . . . . . Subdivision . . . . ,// <br /> Pere. Rate � T T �.a5 <br /> Mobile Home . . . . . . Sanitary C1Dry Well . . . . . . ,I ,� O <br /> (1(lv— `Seepage Trench . . . . . . 10 fO <br /> Privy . . . . . . / Building '� fn W <br /> Well Well .< <br /> 4/ . . . . -moo <br /> . � Privy .. <br /> Subdivision . . . . . . Other (Specify) . . . . . . Seepage Bed <br /> Conditional . . . . . . <br /> 2. Classification Land Use . . . . . . <br /> Zoning Dist. _,'-i <br /> 6. Use (describe exact( 1 -fam) <br /> 3. Lot Size home, motel, etc.) FOR COMMERCIAL USE �: _ J`v ° i <br /> . . . . . . . . . ft. x . . . . . . . . ft. Plans Submitted . . . . . . °�- <br /> . .�.r'f.C.6'. A'.f. sq. ft. Plans Approved . . . . . . <br /> ----- — ---- ------�1 ---- <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 <br /> \ and setback from all bodies of water. <br /> P <br /> If property is located at a highway in- <br /> \\ <br /> tersection, show the intersecting high- '�"A :C3 <br /> ways and the setbacks required along <br /> them and at the intersection. <br /> so J—� aC <br /> PERMIT FEES <br /> hlr r0 �� A Subdivision..... $25.00 + $2.00 per lot. fD <br /> Land Use................................. $10.00 <br /> Building................................... 10.00 <br /> Sanitary .................................. 20.00 ;✓� <br /> Well ........................................ 10.00 <br /> Septic Tank ............................ tee '5,00 <br /> Privy ....................................... 5.00 <br /> .... .�raOw <br /> �L ....... ....... . .... inistrator <br /> ..... ... ...... <br /> ignatu?eorppAge t �Danmg A m' <br /> 1 � I spection Date ...:.../L.. ..Q.jl...................... Inspector .,l :J��l��,v..Ga..:��;/-l' ::�..'.. ...................... <br /> s Remarks y.A ..... .. .... .... <br /> ....G...e......:z. ... <br /> ...................... . / �/ �..,/. .......... <br /> ( La :7i. ('l�C: ::v. .,: �.. ....... .. ... ..... .................... <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 />