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Burnett County Office of Zoning Administrator o `C� zP <br /> CD CD 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT °. 3 <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 y ;Q <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. O <br /> y/ ,�Jf d <br /> U t G'f f L Q j't� I'l t` f` �1,dqe � �( '* `D �G.Owner or Agent (please print) Contractor or Sveyor <br /> .� j.. <br /> CD <br /> CL <br /> Address Address a <br /> Phone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Phone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ^°9 �� <br /> Plumber Well Driller <br /> .n . . . . . . . . . . . . . . . . . . . ' <br /> Address ddress � CD o <br /> `t`` �. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> Phone Phone rt o <br /> m o <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: � ° <br /> Type of Construction No. Bathrooms �• o Z °o <br /> 1. Work . . . . . . . . . . . . . . . . . . . . . . . . No. Bedrooms • • ° <br /> New Building . . . . . . Size . . . . . ft. x . . . . . . ft. Septic Tank Size Gals, <br /> Addition . . . . . Height . . . . . Stories . . . . . . . . . . . . <br /> Sanitary Area . . . . . . . . . . . . . . . . . . . 7a.Absorption Field Site• <br /> r <br /> Soil Type . . is . . . . . . . . :G1 <br /> Filling . . . . . . '� ' o <br /> Sloe . , �l c : r« <br /> Moving . . . . . . 5. Permits Required p ��• <br /> Grading . . . . . . Subdivision • • . Perc. Rate . . . . . . . . . . . . . . T T :G <br /> Mobile Home Sanitary • • • • Dry Well M CD 5 <br /> Privy . . . . . . Building Seepage Trench . . . . . . fD CD :(Well . . . . . . Well Privy . . . . . . <br /> Subdivision . . . . . . Other (Specify) . . . . . . Seepage Bed j/` o <br /> 0 <br /> Conditional . . . . . . (n M <br /> 2. Classification Land Use . . . . . . s <br /> Zoning Dist. f;tj q <br /> 6. Use (describe exactly, 1 fam. 1^ I y <br /> 3. Lot Size home, motel,etc.) FOR COMMERCIAL USE ° <br /> . . . . . . . . . ft. x . . . . . . . . ft. Plans Submitted . . . . . . <br /> $. . sq. ft. Plans Approved <br /> ——————————————————————————————————--—————--———————— p———————————— i <br /> Fig. A. Location of proposed structures and <br /> existing structures, well, sewage sys- 0 <br /> tems, roads, etc., should be sketched <br /> in Fig. A. Include road setback, side i <br /> and back yard dimension and location 7� a <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 /> them and at the intersection. <br /> PERMIT FEES <br /> Subdivision..... $25.00 + $2.00 per lot. fD <br /> Land Use................................. $10.00 <br /> Building................................... 10.00 : C. <br /> Sanitary .................................. (�5 <br /> Well ........................................ 10.00 : L <br /> Privy ....................................... 5.00 <br /> y� �..... `.. 5 ,.................................... <br /> ............................. ...... ....................... ... <br /> Signature of Owner or gent Date 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 />