Laserfiche WebLink
Burnett County Office of Zoning Administrator ' ' <br /> o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT °. 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application fora = o <br /> Permit for the work described and located as shown herein. The undersigned agrees that all d <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- -0 <br /> lations of the State of Wisconsin. ON COMPUTER/SCANNED 3 d 41 o <br /> �iou e oG•GzGiP S. _. <br /> Owner or Agent (please print) Contractor or Surveyor <br /> ` ' •� <br /> Address Address <br /> 8� - 83.1`??. . . . . . . . . . . . . . . . . . . p� - <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> Phone Phone <br /> �. . . /�-flJ.'11 .�. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> Plumber / Well Driller ;Y ( r <br /> Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> � o <br /> o <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> Phone Phones <br /> �1 m o <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: 1 <br /> Type of Construction No. Bathrooms 2• • --• ZZ 0 <br /> . . . . . No. Bedrooms. Work <br /> New Building �. . Size <br /> � ft. x . ft. Septic Tank Size Gals. :�J <br /> Addition Height . . . . . Stories . f. . . . . C Y_; <br /> Sanitary . .v . Area . . .<<f0.4. �.�. . 7a.Absorption Field Site: I :Tn <br /> Filling . . . . . . Soil Type . . . . . . . . . . . . . . . . . . O V1 :(� o <br /> Moving . . . . . . 5. Permits Required Slope <br /> . . . . . . . . . . . . . . . . . . . . `IST T <br /> g Perc. Rate Q <br /> Gradin . . . . . . Subdivision . . . . . . • • • - • • • • • • - • - - - • - - .• : I <br /> Mobile Home Sanitary �� Dry Well . . . . . . <br /> Privy . . . . . . Building /i, Seepage Trench . . . . . . fa <br /> Well . . . . . . Well Privy Q tV <br /> Subdivision . . . . . . Other (Specify) Seepage Bed /. '•�'•3� ) o n <br /> Conditional o Cn rn <br /> 2. Classification /�/� Land Use _ S <br /> Zoning Dist. !( /1 ; o a o <br /> 6. Use (describe exactly, 1 -fam: : 1 N' <br /> o <br /> 3. Lot Sizehome, motel,etc.) FOR COMMERCIAL USE � <br /> 420. . . . ft. x . 08. . ft. Plans Submitted <br /> y`sq. ft. Plans Approved . . . . . . ;A • <br /> Fig. A. Location of ------- es <br /> proposed structures and and <br /> existing structures, well, sewage sys- 'S :�o <br /> T` C �` N ? tems, roads, etc., should be sketched :ti :� <br /> /fes in Fig. A. Include road setback, side <br /> d and back yard dimension and location j o <br /> and setback from all bodies of water. <br /> Spm If property is located at a highway :� <br /> tersection, show the intersecting high- ( <br /> ways and the setbacks required along o <br /> L, 1 • them and at the intersection. <br /> oil <br /> �l <br /> �1 PERMIT FEES <br /> . . . . . . . . <br /> � y Subdivision $15.00 • <br /> J Land Use . . . . . . . . . . . <br /> Building . . . . . . . . . . . 5.0 <br /> Sanitary . . . . . . . . 10.0 <br /> Well . . . . . . . . . . . 5.00 :C <br /> Septic Tank . . . . . . . 10.00 <br /> Combination Building, Sanitar <br /> and Well . . . . . . . . 15.00 <br /> Privy . . . . . . . . . . . . 5.00 0i <br /> 9 A <1 <br /> 30� <br /> ...... ...... ........ . . ................. X0/� ..8....... . .. .. .Signature o Owner est / Zo g inistrator <br /> Inspection Date . a� .�1. �. �..d ...... Inspector ........ 1� (( . ... .. .rill <br /> / . <br /> Remarks ... .......... .......I......... .. .. ................... <br /> ........................................ .. ...... ............�:-. ....... r.�................................................................................... <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 />