Laserfiche WebLink
Burnett'County Office of Zoning Administrator ° ��"fin <br /> N p Z <br /> m m y p O <br /> ARRLICATION FOR SANITARY — LAND USE — BUILDING PERMIT �. 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, <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- o- <br /> lations of t o State of Wisconsin.- <br /> ru ct ( s � . . . . � C 3 J <br /> Owner or Agent (please print)Y ContrActor orr Sur yor H i,� <br /> to 1.07. . z-�,, f� R 6 Q. J <br /> Addres Address a <br /> Phone Phone _ <br /> :tom <br /> Plumber Well Driller <br /> v <br /> Address Address 0 o :r <br /> �U. " ' c <br /> . . . . . . . <br /> Phone Phone 0 0 <br /> � o <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: <br /> Type of onstructi n No. Bathroomso Z °o <br /> 1. Work ' / . .`r�. . . No. Bedrooms ° <br /> New Building <br /> . . . . . . Size ft. x ft. Septic Tank Size Gals. <br /> Addition . . . . . . Height ::::: Stories : : : : : : S. <br /> Sanitar ✓. . Area 7a.Absorption Field Site: <br /> Filling . . . . . Soil Type . . . . . . . . . . . . . . . . . . .V .� T a <br /> Moving 5. Permits Required <br /> Slope k�Vj <br /> Grading . . . . . . Subdivision . <br /> Perc. Rate I <br /> Mobile Home . . . . . . Sanitary : : Dry Well . . . . . . m � <br /> Privy / Building Seepage Trench 60 r�\ <br /> Well ✓ <br /> . . . Well Privy <br /> �pp <br /> /0 o <br /> Subdivision . . . . . . Other (Specify) . . . . . . Seepage Bed � o <br /> Conditional . . . . . . N N <br /> 2. Classification Land Use a a <br /> Zoning Dist. . . . . . . zi' o <br /> 6. Use (describe exactly, 1 -farn H' <br /> o <br /> 3. Lot Size home, motel, etc.) FOR COMMERCIAL USE <br /> r<Q.U. . .ft. x ft. Plans Submitted . . . . . . <br /> . . . . . . . . . . . . . . . . . . sq. ft. Plans Approved . . . . .. <br /> ------------------------------------ ------------- proposed <br /> ------------ '� <br /> J; <br /> Fig. A. Location of ro posed structures and <br /> existing structures, well, sewage sys- J <br /> tems, roads, etc., should be sketched <br /> l„� (�✓ in Fig. A. Include road setback, side s <br /> and back yard dimension and location <br /> and setback from all bodies of water. <br /> If property is located at a highway in- <br /> tersection, show the intersecting high- <br /> IIways and the setbacks required along <br /> S them and at the intersection. <br /> PERMIT FEES <br /> ►a Subdivision . . . . . . . . $15.00 m <br /> Land Use . . . . . . . . . . . 1.00 <br /> \ Building . . . . . . . . 5.00 <br /> Sanitary 10.00 <br /> Well . . . 5.00 <br /> Septic Tank . . . . . . . . . 1.00 <br /> � y� 1 Combination Building, Sanitary•'�'��a l �V\C`t and Well . . . . . . . 15.00 <br /> Privy . . . . . . . . . . . 5.00 <br /> , % -� .- ...... <br /> ... <br /> Signature of Owne� or Agent Date y� Zonin dministrator <br /> Inspection Date .............�0• 7 ................. Inspector .. ....af� ...................................................... <br /> Remarks .. ..... ��1 ��.................................... ......................... .......................... <br /> 1. .... <br /> .......0.......... .1�..1J,��y... W.....!9f..-..1>.r.�I% .......0............... <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 />