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Burnett County L� Office of Zoning Administrator o --i z <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> 7 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a = o <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- a <br /> lations of the State of Wisconsin. <br /> Ou4ner or Agent (please print) Contractor or Surveyor <br /> 40 <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> . . . . . . . c <br /> Address Address a \ <br /> Phone Phone <br /> L . IJ/Po%�r r- So,�s ./.ice :. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> . . . . . ov <br /> Plumber Well Driller r� <br /> :v Rl <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _. <br /> Address Address n o <br /> `- � <br /> Phone Phone <br /> r <br /> \ o <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: s ~ <br /> Type of Construction o <br /> . O 0 <br /> 1. Work . . . . . No. Bedrooms • • ° <br /> New Building . . . . . . Size . ;Wk ft. x . . ft. Septic Tank Size Gals. zl�En <br /> Addition . . . . . . Height .4*�. Stories ✓. . . . . <br /> Sanitary Area . . . 7a.Absorption Field Site: <br /> Filling Soil Type . . . �• a `.�. . . . . . G o <br /> . . . . . /. ev :. . <br /> Moving . . . . . . 5. Permits Required Slope . . . . . . <br /> Grading . . . . . . Subdivision Perc. Rate . . . . . . . . .7. . . . . . <br /> Mobile Home . . . . Sanitary . ,., Dry Well . . . . . . ' <br /> Privy . . . . . . Building Seepage Trench . . . . . . fA <br /> : �y <br /> Well . . . . . Well Privy <br /> Subdivision . . . . . . Other (Specify) . . . . . . Seepage Bed !gx 3S <br /> Conditional . . . . . . i C N <br /> C m <br /> 2. Classification Land Use a <br /> Zoning Dist. 0 <br /> 6. Use (describe exactly1 -fam. N <br /> 3. Lot Size ome motel,etc.) FOR COMMERCIAL USE ;pp <br /> . . . . . . ft. x . . . . . . . ft. Plans Submitted G :N <br /> 6e;e./-),�. r-. . . . sq. ft. Plans Approved . . . . . . <br /> -—————— -------------------------- --- ------ <br /> Fig. A. Location of proposed structures and <br /> existing structures, well, sewage sys- 'b o <br /> �Ib .ZU tems, roads, etc., should be sketched Inn <br /> in Fig. A. Include road setback, side is <br /> vh and back yard dimension and location a <br /> Q ` ukA,— and setback from all bodies of water. <br /> 1 If property is located at a highway in- , <br /> 3 \ tersection, show the intersecting high- j <br /> ways and the setbacks required along r7 <br /> them and at the intersection. <br /> D� t(toP 22U Vi 70 <br /> PERMIT FEES <br /> Subdivision..... $25.00 + $2.00 per lot. ° <br /> r Land Use......0.......................... $10.00 h <br /> q 2C b l'�P , B uiLcLL <br /> ^^ t„v.. 10.00 V <br /> S a n if a ry___2 ........... <br /> .iu ........ Q 1 <br /> b i- <br /> .... <br /> ........................................ 10.00 <br /> S »I< ............................ �6W� <br /> 18©" Privy ....................................... 5.00 cC <br /> 75 <br /> '6.N c ,Cys-tib �. ... .Y. .... . . .. .. .. . ........7.. r �.... ................. <br /> . ... . ...:. ®rOmlr�istrato <br /> Signature of Owner or Agent J Date Zr <br /> Inspection Date ........... .............. ...... ...................... Inspector .......... ................. ..............................T ...................... <br /> ..... <br /> Remarks .. .... ... 0 ��. ...... ..GRI...........:...Y� 7Cf � ?!.1�:............................... <br /> ��.... �.... .. ...... —...................................................... <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 />