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Burnett County Q 1: ., Office of Zoning Administrator <br />APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <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 <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- <br />lations of the State of Wisconsin. <br />Owner or Agent (please print) Contractor or S'urveyo( ............ <br />............�.:1.... m ....... <br />Address Address <br />Phone. ............................. <br />C4�- S.....1�e r2�c t2 .......... <br />Plumber <br />t,J 35:T. �. .....t ..... <br />Add* ress <br />4................... . <br />Phone <br />- _r <br />o, <br />CD CD3 <br />d H <br />0 � <br />CD <br />CL <br />co <br />3 <br />co <br />CL <br />a <br />m <br />m <br />.................................... <br />Phone <br />1 <br />Well Driller <br />C/) <br />co <br />............................... <br />New Building <br />Address <br />Size 2 .. ft. x o. ft. <br />� <br />Addition <br />i� <br />Phone ............................... <br />CD <br />DESCRIPTION <br />4. Building Details <br />1. Work <br />C/) <br />co <br />Type of Construction, t -I <br />LCvFe<- �"� <br />. . <br />New Building <br />...... <br />Size 2 .. ft. x o. ft. <br />� <br />Addition <br />Height i.L�. tories ..I.... <br />Sanitary <br />Waste Disposal System <br />Septic Tank Size Gals. <br />Area .... <br />Alterations <br />...... <br />Soil Type .. <br />Moving <br />...... <br />5. Permits Required <br />Wrecking <br />...... <br />Subdivision <br />Mobile Home <br />...... <br />Sanitary a✓ <br />Privy <br />LO <br />ID <br />Building <br />Well <br />... <br />Well . ✓ . . <br />Subdivision <br />..... <br />Other (Specify) - ...... <br />2. Classificationpm <br />Conditional ...... <br />Land ...... <br />Zoning Dist. <br />6. Use (describe exactly, - fam,,i <br />3. Lot Size home, motel, etc.) FOR COMMERCIAL USE <br />/4�P ft. x S�-P. ft. Plans Submitted ...... <br />.................. sq. ft. Plans Approved ...... <br />------------------------------------------------------------------- <br />Fig. A. r Location of proposed structures and <br />existing structures, well, sewage sys- <br />tems, roads, etc., should be sketched <br />in Fig. A. Include road setback, side <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 />ways and the setbacks required along <br />5S���-, / them and at the intersection. <br />m <br />7. Sanitary Facilities <br />C/) <br />co <br />No. Bathrooms <br />z z <br />Dishwasher ...... <br />0 0 <br />Garbage Grinder ...... <br />Autom. Laundry <br />No. Bedrooms <br />4orrl l <br />Waste Disposal System <br />Septic Tank Size Gals. <br />Sanitary . . . . . . . . . . <br />Absorption Field Sit <br />3,��! .... <br />CD CD <br />Soil Type .. <br />. 5_.00 <br />SlopezLO...... <br />Perc. Rate ?. %n.�n!..... <br />#� <br />... <br />Dry Well <br />o <br />o <br />Seepage Trench ...... <br />V I <br />Privy <br />Seepage Bed <br />LO <br />ID <br />3. Lot Size home, motel, etc.) FOR COMMERCIAL USE <br />/4�P ft. x S�-P. ft. Plans Submitted ...... <br />.................. sq. ft. Plans Approved ...... <br />------------------------------------------------------------------- <br />Fig. A. r Location of proposed structures and <br />existing structures, well, sewage sys- <br />tems, roads, etc., should be sketched <br />in Fig. A. Include road setback, side <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 />ways and the setbacks required along <br />5S���-, / them and at the intersection. <br />DRA�uF��to SSFQ•M� <br />5LP77C r4wt` 35 - <br />PERMIT FEES <br />C <br />C/) <br />co <br />Subdivision . . . . . . . . . <br />4�tID <br />CD <br />Land Use . . . . . . . . . . <br />ntolalLE <br />Building <br />4orrl l <br />'�4 <br />Sanitary . . . . . . . . . . <br />. 10.00 <br />0 <br />Well . . . . . . . <br />. 5_.00 <br />DRA�uF��to SSFQ•M� <br />5LP77C r4wt` 35 - <br />o Z <br />d o <br />PERMIT FEES <br />C <br />C/) <br />co <br />Subdivision . . . . . . . . . <br />$15.00 <br />CD <br />Land Use . . . . . . . . . . <br />. 1.00 <br />Building <br />5.00 <br />'�4 <br />Sanitary . . . . . . . . . . <br />. 10.00 <br />0 <br />Well . . . . . . . <br />. 5_.00 <br />E744_ <br />Septic Tank . . . . . . . . <br />. <br />u <br />Combination Building, Sanitary <br />and Well 15.00 <br />o Z <br />d o <br />CD <br />o <br />C <br />C/) <br />co <br />•0CD\Y1\J1 <br />0 <br />CD <br />1� t <br />onad'�m4i <br />....,............................... ,5=.3�:?7................... ......... ......Signature of Owner or A�tgent ��JDate � onnistrator <br />Inspection Date �..lV........ ,/ /. Inspector .. a .. 2_ .................................. <br />Remr k s l� cC C ... ?Z1" !ir................................................................................................................. <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 />Cn <br />c <br />C/) <br />co <br />< <br />0 <br />0 <br />0 <br />:C <br />ii�j <br />- C <br />:n <br />LO <br />ID <br />1� t <br />onad'�m4i <br />....,............................... ,5=.3�:?7................... ......... ......Signature of Owner or A�tgent ��JDate � onnistrator <br />Inspection Date �..lV........ ,/ /. Inspector .. a .. 2_ .................................. <br />Remr k s l� cC C ... ?Z1" !ir................................................................................................................. <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 />