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Office of Zoning Administrator � �� z <br /> Burnett County m o 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT a 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 <br /> work shall be done in accordance with the requirements of the County Zoning Ordinance, v a N . <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- <br /> lations of the State of Wisconsin. <br /> a <br /> 3 d <br /> O <br /> Contractor or Surveyor <br /> Owner or Agent (please printf. <br /> ',/ c <br /> / 111e, f kY ,S� <br /> .S r. !27 � a . <br /> . ' °u'. .<. . . .J . . . . . . . . . . / ' Address <br /> Address d <br /> . . . . . . . . . . . . <br /> Phone <br /> Phone <br /> v pCt �dk �/Kc . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .� <br /> Plumber Well Driller <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . c) 1 <br /> Address Address ° <br /> 0 <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . n h o <br /> Phone Phone a <br /> / D p <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: 2 Z <br /> Type of Construction No. Bathrooms <br /> YP 0 °�� • <br /> 1. Work No. Bedrooms . . . . . . -. <br /> New Building . . . . . . Size . . . . . ft. x . . . . . . ft. Septic Tank Size Gals. <br /> Addition . . . . . . Height . . . . . Stories . . . . . . . . . . . • <br /> Sanitary Area 7a.Absorption Field Site: -J <br /> y . . . . . . Soil r <br /> Typyy• <br /> . . . . . . <br /> . . . . . . Slope . . . aV.Filling <br /> N <br /> . . . . . . 5. Permits Required <br /> Moving <br /> J . J. . . . . . . . . . <br /> G . . <br /> ad ng . . . . . Perc. Rate .. <br /> Subdivision Dry Well <br /> Mobile Home B?nlaany Seepage Trench m ,1 <br /> Privy g <br /> Privy <br /> Well . . . . . . Well . . . . . . Seepage Bed (,, <br /> . . . . . . Other (Specify) oSubdivision <br /> ' <br /> rn rn <br /> Conditional . . . . . . i QS c <br /> Q <br /> 2. Classification Land Use ^ a o <br /> Zoning Dist. . . . . . . tj\ <br /> 6. Use (describe exactly, 1 -tam. N <br /> 3. Lot Size home, motel,etc.) FOR COMMERCIAL USE \ ° <br /> . . . . . . . . . ft. x . . . . . . . . ft. Plans Submitted . . . . . . - : k <br /> Plans Approved . . . . . . <br /> . . . . . . . . . . . . . . . . . . sq. ft. . -''f- <br /> ___ ---- <br /> -------- ------- <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 W s <br /> and back yard dimension and location i k/ a <br /> and setback from all bodies of water. <br /> (� t If property is located at a highway in p �^ <br /> tersection, show the intersecting high- <br /> way s <br /> igh-ways and the setbacks required along i r <br /> Lthem and at the intersection. <br /> PERMIT FEES <br /> Subdivision.....$25.00 + $2.00 per lot. <br /> Land Use................................. $10.00 <br /> / Building................................... 10.00/t p a)t Sanitary .................................. 20.00 <br /> WeII ........................................ 10.00 <br /> Septic Tank ............................ 10.00 <br /> _ Privy ....................................... 5.00 <br /> Ico4 <br /> Se lic rtiek � �} �� �/_... ... .:.. p.F�.c�l `! ....... Gct� �.g A�. .' i strator..................... <br /> na aaaxxx��� Zonin <br /> Inspector ..... <br /> ._ l� . ..... .............. ........ . .... ...................................... <br /> Inspection ate ............... . ........ ................ <br /> Remarksj.. ........................................................................................................... <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 />