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Burnett County Office of Zoning Administrator Cn -0 0 __4 z <br /> CD � n 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT ° � CD <br /> T,0 THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a 0 :'C <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. -- � (� p <br /> Owner or Agent (please print) Contractor or Surve or <br /> c :\ • <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> Address Address <br /> CD <br /> r <br /> Phone Phone :IX <br /> Plumber Well Driller <br /> Address Address ' m G� <br /> 20 �� <br /> 0 0 <br /> 4,11 ='• � Cl <br /> " . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> Phone Phone \ CD o :'b* <br /> m 0 <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: <br /> Type of Construction No. Bathrooms • • o z 0 <br /> .a <br /> 1. Work No. Bedrooms 0 <br /> CD <br /> New Building . . . . . . Size . . . . . ft. x . . . . . . ft. Septic Tank Size Gals. <br /> Addition Height . . . . . Stories . . . . . . . . . . . . W <br /> Sanitary Area 7a.Absorption Field Site: <br /> Filling Soil Type . . 'y.1114 . . . . . . °C) 0 <br /> Moving 5. Permits Required Slope .76 . . . . . . . . . . .. h <br /> Grading . . . . . . Subdivision Perc. Rate . . . . . . 3. . . . . . . . . <br /> Mobile Home . . . . . . Sanitary j Dry Well . . . . . . m m <br /> Privy . . . . . . Building . , . , , • Seepage Trench . . .« fD CD <br /> Well Well Privy <br /> . . . . <br /> Subdivision . . . . . . Other (Specify) . . . . . . Seepage Bed . . . . . . o <br /> Conditional . . . . . . 00 <br /> c CD <br /> 2. Classification Land Use <br /> Zoning Dist. . . . . . . / o <br /> 6. Use (describe exactly, 1 -fam. <br /> 3. Lot Size home, motel,etc.) FOR COMMERCIAL USE 0 <br /> . . . . . . t. x . . . . . . . . ft. Plans Submitted . . . . . . <br /> r. . sq. ft. Plans Approved <br /> ---------------------------------------- <br /> Fig. A. Location of v s 'proposed structures and � <br /> existing structures, well, sewage sys- 0 <br /> tems, roads, etc., should be sketched 0 <br /> in Fig. A. Include road setback, side s <br /> and back yard dimension and location a <br /> and setback from all bodies of water. <br /> If property is located at a highway in- ?S . <br /> tersection, show the intersecting high- :( <br /> ways and the setbacks required along <br /> them and at the intersection. <br /> PERMIT FEES <br /> Subdivision..... $25.00 + $2.00 per lot. fD <br /> Land Use................................. $10.00 <br /> Building................................... 10.0 <br /> Sanitary 35.0 -' <br /> ................................ . <br /> Well ........................................ 10.00 _ <br /> Privy ....................................... 5.00 <br /> atu of Owner r Sign re Agent ate Zoning Administrator <br /> InspectionDate ................................................ Inspector ................................................................................................ <br /> Remarks ............................................................................................................................................................ <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 />