2016/06/15 - SANITARY - SAN - Other

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Burnett County Office of Zoning Administrator APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT o 3 F TO THE ZONING ADMINISTRATOR: The undersigned,hereby makes application for a = o 1 5 Permit for the work described and located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the County Zoning Ordinance, m Sanitation Code, and with all other applicable County Ordinances and the laws and regu- -0a lations of the State f Wisconsine r- . a �— —�— f. . . 3 Owner or Agent (please print) Contractor or Surveyor d . . C.I k�-n ct r I1,o k`E'. . �L r}�i�. . . . . . . . . . . . . . �?^� . . a ® V1' 74� Address r h r1 . � U y Address ' a N rpv ?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ' Phone Phone . .�� Plumber Well Driller . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Address • Address m G'> 0 :m Phone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Phone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ' :,.-:zN „ r Xl 1 c, o DESCRIPTION 4. Building Details 7. Sanitary Facilities: v \ Type of Constn]CtigQ_, No. Bathrooms o Z �° .jJ 1. Work � .X(S 1./. h.�. . No. Bedrooms . New Building . . . . . . Size . A9 ft. x .3. .0. . ft. Septic Tank Size Gals. �. �. � o � Addition . . . . . . Height . . . . . Stories . . . . . . Sanitary ✓. Area 7a.Absorption Field Site: II m Filling . . . . . . Soil Type . . . . ..S ft!?. .a . . . ` • O Moving . . . . . . 5. Permits Required Slope -C QJ G Grading . . . . . . Subdivision Perc. Rate . . .��c. . . . Mobile Home Sanitary �— Dry Well m m Privy . . . . . . Building Seepage Trench . . . . . . Well . . . . . . Well . . . . . . Privy �p Subdivision . . . . . . Other (Specify) . . . . . . Seepage Bed Conditional . . . . . . ;n{ m N c m 2. Classification Land Use . . . . . . b Zoning Dist. . . . . . . o < � 6. Use (describe exactly, 1 -fam. 3. Lot Sizehome, motel,etc.) FOR COMMERCIAL USE 0 10.0. . . ft. x 0PP ft. Plans Submitted 1 . . . . . . . . . . . . . . . . . . sq. ft. Plans Approved . . . . . . ;/- P -------------------- ---------------------------------------- Fig. A. Location of proposed structures and existing structures, well, sewage sys- tems, roads, etc., should be sketched i r in Fig. A. Include road setback, side s �h and back yard dimension and location L I a and setback from all bodies of water. If property is located at a highway in- - V tersection, show the intersecting high- � = Ijp)� ways and the setbacks required along them and at the intersection. Q : I PERMIT FEES Subdivision . . . . . . . . . $1$.00 i 7 49 fr Land Use . . . . . . . . . . . 1.00 �^T Building . . . . . . . . . 00 ti �g1/17 Sanitary . . . . . . . Well Septic Tank . . . . . . . . . 1.00 Combination Building, Sanitary and Well . . . . . . 15.00 Privy . . . . . . . . . 5.00 ` _- O3 7 `...... . .. ..... -t ctrl 9 g �� I 9.. ..�1 .................... Si n Lure of O er or A gent Date � o in d inistrator InspectionInspector � l Vic. ..... ............................... Remarks J!` . ..C. .d'T �--� ...................................................................................................... ................................................................................................................................................................................................ ................................................................................................................................................................................................ NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to this application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build- ing until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- with is found to exist. Changes in plans or specifications shall not be made without approval of the Zoning Administrator. SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED.