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Burnett County Office of Zoning Administrator U <br />C CD <br />APPLICATION FOR SANITARY — LAND USE—_QUILDING PERMIT C <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 y <br />work shall be done in accordance with the requirements of the County Zoning Ordinance,CD <br />Sanitation Code, and with all other applicable County Ordinances and the laws and regu- v 0- <br />�- <br />lations of the State of Wisconsin. `�° ° VJ 1 O <br />h CD <br />a <br />. <br />Owner or Agent (please print) Contractor or Surveyor <br />Address Address <br />CD <br />..................................... <br />Phone Phone <br />.7744�1Af o..�,1`"I..... ............................ 1 �•� <br />Plumber Well Driller <br />Address f Address G) <br />o <br />0 `. <br />Phone •�...... ate.. �� .............. Phone ............................... r <br />CD <br />0 - o � 1- <br />m o r' <br />DESCRIPTION 4. Building Details 7. Sanitary Facilities: ° <br />Type of Construction No. Bathrooms • • • ! • • o z 0a ' <br />1. Work ........................ No. Bedrooms o „ <br />New Building ...... Size ..... ft. x ...... ft. Septic Tank Size Gals.J�a <br />Addition Height ..... Stories ...... v i <br />Sanitary Area 7a.Absorption Field Site: <br />Filling ...... Soil Type .... .S /t-�..... \ o <br />Moving q Sloe o - <br />..... 5. Permits Required P l • • • • • y <br />Grading ...... Subdivision Perc. Rate ................. � <br />Mobile Home ...... Sanitary Dry Well ......CD CD <br />:\ <br />Privy ...... Building Seepage Trench `D CD <br />Well ...... Well Privy p' ... '� <br />Subdivision ...... Other (Specify) ...... Seepage Bed ��i. y. o :1 ) <br />Conditional j�7 cn Cn <br />CD <br />2. Classification Land Use ...... : ( :� � <br />Zoning Dist. qR 0- <br />0 <br />6. Use (describe exactly, 1 - fam. H' ' <br />3. Lot Size ome, otel, etc.) FOR COMMERCIAL USE <br />......... ft. x ........ ft. Plans Submitted 'n o <br />sq. ft. -- Plans Approved ...... <br />--------- ---- - - - - - - - - - - - - - - - - - - - - :m <br />Fi . A. ^� Location of proposed structures and <br />t/� existing structures, well, sewage sys- �:I o <br />A� �$' tems, roads, etc., should be sketched :q7 <br />in Fig. A. Include road setback, side <br />and back yard dimension and location N <br />and setback from all bodies of water. :h, <br />tb If property is located at a highway in- :0 : u <br />tersection, show the intersecting high- <br />S ways and the setbacks required along <br />JOi them and at the intersection. it <br />+ PERMIT FEES i <br />r $ Subdivision $15.00 <br />Land Use. . . . . 1.00 N <br />Building . . . . . . . . . . 0 <br />Sanitary . . . . . . . . . 10.0 <br />n Well . . . . . . . . . . <br />�1 Septic Tank . . . . . . . . 1�0 <br />K Combination Building, Sanitary <br />and Well 15.00 <br />Privy . . . . . . . . . . . . 5.00 <br />0 <br />........... ....... ............. ..,......! ...... .. ............... <br />Signature of Owner or Age t Date oni Administrator <br />Inspection Datet..�..^. ./...�......... Inspector .. �.../�./....f <br />Remarksll�.`--............-........................................................................... <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 />