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4 Burnett County Office of Zoning Administrator CD <br />K t " <br />APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br />TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a <br />Permit for the work described and located as shown herein. The undersigned agrees that all y <br />work shall be done in accordance with the requirements of the County Zoning Ordinance, m <br />Sanitation Code, and with all other'applicable County Ordinances and the laws and regu- °- <br />lations of the State of Wisconsin. a <br />+ m <br />Owner oAgent (please print) Contractor or SurveyorCD <br />N <br />c <br />Addressf/ .. Address .............................. <br />'!� .. ........� .�................................ <br />Phone Phone <br />Plumber Well Driller <br />....................................................................... <br />Address Address <br />Phone <br />....... r�vP............... <br />Phone <br />DESCRIPTION <br />1. Work <br />New Building ...... <br />Addition <br />Sanitary ...4-!' <br />Filling ...... <br />Moving ...... <br />Grading ...... <br />Mobile Home ...... <br />Privy ...... <br />Well ...... <br />Subdivision ...... <br />2. Classification <br />Zoning Dist. <br />3. Lot Size <br />4. Building Details <br />Type of Construeerr <br />Size ..... ft. x ...... ft. <br />eight ..... Stories ...... <br />Area................... <br />5. Permits Required <br />Subdivision ...... <br />Sanitary ...L,� <br />Building ...... <br />Well ...... <br />Other (Specify) ...... <br />Conditional ...... <br />Land Use ...... <br />6. Use (describe exactly, 1 Lam <br />h� motel, etc.) <br />7. Sanitary Facilities: I <br />No. Bathrooms .. . <br />No. Bedrooms ... <br />Septic Tank Size Gals. <br />7a.Absorption Field Site: <br />Soil Type .................. <br />Slope.................... <br />Perc. Rate ................. <br />Dry Well ...... <br />Seepa e Trench <br />Privy a� <br />Seepage Bed �• <br />FOR COMMERCIAL USE <br />C <br />CD <br />m <br />Z Z <br />0 0 <br />-WI <br />.. ft. x .. ft. Plans Submitted <br />a ....c......:.... sq. ft. Plans Approved ...... <br />---------------------------------------------------------------- <br />Fig. <br />Location of proposed structures and <br />existing structures, well, sewage sys- <br />tems, roads, etc., should be sketched <br />f*Q , in Fig. A. Include road setback, side <br />ty� and back yard dimension and location <br />f A and setback from all bodies of water. <br />�y SIL go If property is located at a highway in <br />Art ` tersection, show the intersecting high- <br />ways and the setbacks required along <br />them and at the intersection. <br />ItJ PERMIT FEES <br />Subdivision..... $25.00 + $2.00 per lot. <br />Land Use ............. $10.00 <br />Building .................................. 10.00 <br />Sanitary .................................. -•2Q-49.Q <br />Well........................................ 10.00 <br />Septic Tank ............................ 10.00 <br />Privy....................................... 5.00 <br />CD <br />� <br />o <br />o <br />H <br />r. <br />0 <br />G <br />iG <br />0 <br />o <br />_.. <br />CD <br />0 <br />:4 <br />�+ <br />c <br />CD <br />a <br />r« <br />o' <br />0 <br />o' <br />N <br />_.. <br />CD <br />