Laserfiche WebLink
lBurnett County Office of Zoning Administrator Gur( <br /> Y O O <br /> APPLICATION FOR SANITARY — LAND7 <br /> USE — BUILDING PERMIT D, 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a y o <br /> Permit for the work described and located as shown herein. The undersigned agrees that all N <br /> work shall he done iu accordance with the requirements of the County Zoning Ordinance, a n <br /> i Sanitation Code, and with all other applicable County Ordinances and the laws and regu <br /> ti — <br /> laces of the S/ya to of Wisconsin. 3 c <br /> .. Cf�.y .�d . . . S I`�•I` 7rr <br /> Owqq er or Agent Please print) Contractor or Surveyor <br /> . i .7 .?.�. . . . .Q t' !46c'Y'C e. . S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . n �,9 H <br /> Address / Address c- <br /> . . . . . . . . . . . . . . . . . . . . . . . . <br /> - <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - <br /> Pttone Phone <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> . . . . . . . . . . . . . . . . . . . . . . . . i <br /> PlafmNer Well Driller ILI� <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _ <br /> O <br /> Address Address A Or <br /> Phone . . . . . . . . . . . .Ph. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . o <br /> Phone one <br /> DESCRIPTION 4. Building Details 7. Sanitary <br /> Facilities: o v <br /> Type of Construction No. Bathrooms o I <br /> No. Bedrooms ° <br /> 1. Work n�l<r4ot. . . . . . <br /> �. . . . (n <br /> New Building . . . . . . Size . . . . . ft. x . . . . . . ft. Septic Tank Size Gals. <br /> Addition . . . . . . Height . . . . . Stories-. . . . . 7a.Absor tion Field Site: 750 <br /> �� <br /> y n <br /> Sanitary Area . . . . . . . . . . . . . . . . . . . p W\ r <br /> Filling . . . Soil Type . . .SK;19. . . . . . <br /> Moving .. . . . . 5. Permits Required slope . . . . . . . . . . . . . . . . . . . . N <br /> Grading . . . . . . Subdivision Perc. Rate . . . . . . . . . . . . . . .� <br /> Mobile Home . . . . . . Sanitary . .a,/ Dry Well <br /> Privy . . . . . . Building . . . . . . Seepage Trench <br /> Well . . . .. . Well . . . . . . Privy . . . . . . � 9l, i <br /> Subdivision . . . . . . Other (Specify) . . . . . . Seepage Bed_ . . . . . . UJ o <br /> Conditional . . . . <br /> 2. Classification Land Use . . . .. . in <br /> a <br /> Zoning Dist. . . . . . . 1 a 0, <br /> O6. Use (describe exactly, -tam a <br /> 3. Lot Size home, motel,etc.) FOR COMMERCIAL USE ( W <br /> . . . . . . . . . ft. x . . .. . . . . ft. Plans Submitted . . . . . . <br /> . . . . . . . . . . . . . . . . . . sq. ft. Plans Approved . . . . . . C � 1 <br /> _______________ _____Fi A. __________________________________'_Z____ : I <br /> g� Locatmn of proposed structures and <br /> existing structures, well, sewage sys- <br /> tems. roads, etc., should be sketched <br /> rV )S in Fig. A. Include road setback, side :y s <br /> N Dry V and back yard dimension and location <br /> 3 s and setback from all bodies of water. <br /> If property is located at a highway in <br /> tersection, show the intersecting high <br /> ways and the setbacks required along <br /> SO• �, them and at the intersection. I <br /> �( h <br /> �W n� PERMIT FEES <br /> Subdivision 5i�ea <br /> has r�� Land Use . . . . . . . . . . 16.00 <br /> Building . . . . . . . . . <br /> Sanitary . . . . . . . . . o.0i�.@0 <br /> Well . . . . . . . . . .10 neo :\F <br /> Septic Tank . . . . . 10.00 A <br /> Combination Building, Sanitary <br /> and Well . . . . . . . . Wr.B& >r <br /> Privy . . . . . . . . . . . 5.00 <br /> Si a['�J e..{{f Owner or 4iyem Date Zon n Istratnr <br /> Inspection Date :.Y...�...:'Z..��.... ..7.9............ Inspector .. ... ... ....... .. ... ............. <br /> Z.'/ �¢ .. ........ <br /> Remarks /./...c!0....1.0.7tr7`--............................................................... ............................... :...I <br /> ............................................................................................................................................................................................N. <br /> (" i <br /> .......... ..... .........I.......I....... <br /> NOTE: A preliminary site inspection must he made and site approval granted on all structures involving Sanitary Id�ljt ie <br /> before construction can begin. In the case of sewerage disposal Systems, a copy of the percolation test must be attached b <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 sof 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 Adm inistratoi <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND ,APPROVED. <br />