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Burnett County Office of Zoning AdministratorCD 0 <br /> APPLICATION FOR SANITARY — LAND U E ="BUILDING PERMIT 0 <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 � N <br /> work shall be done in accordance with the requirements of the County Zoning Ordinance, m ;Vv <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- v <br /> lations of the State of Wisconsin. a (`�' <br /> ,C��!� _ <br /> Owner or Agent (please print) Contractor or. Surveyor H ` m <br /> CD <br /> Address Address <br /> . . . . . . � . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> Ph � • � � Phone <br /> / . . . . . . . O;Vm <br /> Plumber Well Driller ����t` <br /> . .� . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 'Q o <br /> Address Address m O <br /> o <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> . . � o <br /> . . . .Phone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> Phone o <br /> � H r <br /> o <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: -° <br /> v <br /> Type of Construction No. Bathrooms 0 o z <br /> 1. Work s. . . . . . . No. Bedrooms. . o CD <br /> ..New Building . . . . Size L . .0 ft. x ft. Septic Tank Size Gals. � �J <br /> Addition . . ., . . Height . . . . . Stories . . . . . . :� <br /> Sanitary x. . Area 7a.Absorption Field Site: Z/r <br /> Filling . . . . . . Soil Type . . . . . . . . . . . . . . . . . . \ o <br /> Moving q Slope. . . . . . 5. Permits Required Re Pe • • • • • • • • • • • • • • • • • • • • : <br /> Grading . . . . . . Subdivision Perc. Rate . . . . . . . . . . <br /> Mobile Home . . . . . . Sanitary Dry Well . . . . . . M Co <br /> Privy Building . Seepage Trench . . . . . . <br /> Priv `D CD <br /> Well . .�. Well . .� . Y <br /> Q� <br /> o <br /> Subdivision Other (Specify) Seepage Bed . . . . . <br /> o <br /> Conditional . . . . . . (n <br /> 2. Classification f� Z Land Use . . . . . . 1 rt <br /> Zoning Dist. . . . . . . r-3 o <br /> 6. Use (describe exactly, 1 -fam. <br /> 3. L Size / home, motel,etc.) FOR COMMERCIAL USE <br /> . 90 . . . ft. x ft. Plans Submitted . . . . . . 7 <br /> sq. ft. Plans Approved <br /> ------------------------- ---j------------------------------------ <br /> 00 : <br /> Location of proposed structures and <br /> Di ., � y�,,r existing structures, well, sewage sys ; <br /> �/ tems, roads, etc., should be sketched <br /> 7 <br /> 6d in Fig. A. Include road setback, side <br /> P, and back yard dimension and location <br /> 35X 12 Dn "/ and setback from all bodies of water. �a kk <br /> Q a.�%sue / '" If property is located at a highway in <br /> :N <br /> tersection, show the intersecting high- <br /> and the setbacks required along <br /> them and at the intersection. <br /> T./t►�K_ 1`� PERMIT FEES <br /> a�E� <br /> Subdivision . . . . . . . . . $15.00 `D <br /> V tiSC� - �,�p�BSe� 1►'eG� y�. Land Use • . . . . . . . . . . 1.00 <br /> ( _ Building 5.00 <br /> Sanitary . . . . . . . . . . . 10.00 '\ <br /> Well <br /> Septic Tank . . . S15.00 <br /> Combination Building, Sanitar <br /> and Well . . . . . <br /> Privy . <br /> ..... .. ... .. ......................: ./. .. .. .. . .. .... .. .. .. . �.. .... .. <br /> Signature of Owner or Agent Dat nindministrator <br /> Inspection Date ...&.....I..15. ...V........... Inspector ... x.....Z. . . .. ...................................... <br /> Remarks ............�......`.�...................................................................................................................................... <br /> .................................. ..f..l.......5�.................. .....................................................................................................I........ <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 />