2012/07/06 - LAND USE - LUP - Other (3)

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Burnett County Office of Zoning Administrator N 'a o -+ z APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT o 3 TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for ao yt 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, Sanitation Code, and with all other applicable County Ordinances and the laws and regu- lations of the State of Wisconsin. - a 13 es5ie .I_. 3 m 0 O Owner or Agent (please print) Contractor or Surveyor P3Gt c R^� ' r . .X . . 358 {�rhansava V ,s 1P+ 3. . . . . . Ua.n.er'. . . . a 7� ^� Addres . . . . . . . . . . . dre' s r . ✓ v s j a r Rfi, f3o t I l to. . . . . Address 5'k o / 00 S�ppooner Wit 5> ne . . . . . . . / . . . . . . Pho 2F5- s3If6 0U 635 - 3106. . . .Phone 6. b S./�—. . . . . . . . . . — .� LA Plumber Nell Driller Address . . . . . . . . . . . . . . . . . . . p Address n o . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Phone . . . . . . . . . . . . . . . . . . . . . . . . . . . Phone � � � � � � � � � 0 y o 1 DESCRIPTION 4. Building Details 7. Sanitary Facilities: a Type of Construction 1. Work he wood No. Bathrooms . . . . Ccn R nt . b. . . .f. . . No. Bedrooms ° New Building J( . . Size . ./6. ft. x . a ft. tic Tank Size Gals. l Addition � Septic . . . . . . Height . .8. . Stories . /. . . . . . . . . . 11 k} n Sanitary . . . . . . Area . . . 7a.Absorption Field Site: J..f: Nz V , Filling . . . . . . p Soil Type . . . . . . . . . . . . . . . . . . :`C :S ° . Moving . . . . . . 5. Permits Required Slope . . . . . . . . . . . . . . . .. . . " Grading . . . . . . Subdivision Perc. Rate Mobile Home . . . Sanitary . . Dry Well Privy . . . . . . Building . , .15, , Seepage Trench /. . . . . Well Well Privy . . . . . . ' i Subdivision . . . . . . Other (Specify) . . . . . . Seepage Bed . . . . . . \o Conditional ` o 2. Classification 'r" Tv \a Land Use . . . . . . Zoning Dist. Rt Qre a��0� �` °- �. o 6. Use (describe exactly, 1 - fam. - 3. Lot Size home, motel,etc.) FOR COMMERCIAL USE . .�.�0. . . . ft. x ./.X'9?.��. . ft. Plans Submitted - � . . . . .T*.rw-s. .�"" K �r-Q17 C Plans Approved . . . . . . C ______________________________ i3 Fig. A. Location of proposed structures and existing structures, well, sewage sys- tems, roads, etc., should be sketched in Fig. A. Include road setback, side � s and back yard dimension and location and setback from all bodies of water. :z '3 F If property is located at a highway in in ,4ake r tersection, show the intersecting high : ways and the setbacks required along !� them and at the intersection.6 �- PERMIT FEES s Subdivision..... $25.00 + $2.00 per lot. �t O Land Use................................. $10.00 n Building................................... 10.00 Sanitary ..........................4?:.f'.°. 24:99 -n�g Well ........................................ 10.00 i Septic Tank l ............................ 19 89 f W Privy ....................................... 5.00 31 flVy iv-Lr/ \< Signature o Owner or Agent Da e Zoning Administrator InspectionDate ................................. ............ Inspector ................................................................................................ Remarks >: ..a��ac%rY.!!!'r.?c............................................................................................................................ ................................................................................................................................................................................................ .......................................................................................................................................................................................I...I.... 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.