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Burnett County Office of tfoning Administrator <br /> N -D O --1 LZ <br /> CD fD ° ° <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT a 3 CD <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, 77CD <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- CL 7 <br /> CD :lations of the State of Wisconsin. 3 a r O <br /> Owner or Agent (please print) Contractor or Surveyor <br /> CD <br /> CL <br /> Address Address a � �� <br /> a,�br CD <br /> _ <br /> . . . . . . . . . . . . . . . . <br /> Phone /'] Phone <br /> •1J'�^ <br /> . . . . . . <br /> Plumber Well Driller <br /> L. . . . . . . . . . . . Address. . . . . . <br /> . . . . . . . . <br /> . . . . . . . . . . . . . <br /> . . . . r o , <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . CD o <br /> Phone Phone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ° <br /> CDy 0 :Z <br /> CD0 a <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities <br /> Type of Construction No. Bathrooms . . .� . . z z o <br /> ° ° <br /> 1. Work QI)0f'4;).r,41Z.". . . . Dishwasher ° co <br /> New Building X.. . Size .,A . ft. x . .A(- ft. Garbage Grinder . . .> :Q <br /> Addition . . . . . . Height . . Stories . .l. . . Autom. Laundry . . . . . . <br /> i <br /> Sanitary . . Area . . . . . . . . . . . . . . . . . . . No. Bedrooms <br /> Alterations . . . . . . Waste Disposal System . . . ° G <br /> Moving . . . . . . 5. Permits Required Septic Tank Size Gals. <br /> Wrecking Subdivision Absorption Field Site v ' <br /> Mobile Home Sanitary ?� . Soil Type . . . . . ! . . . m <br /> c• co CD —: <br /> Privy . . . . . . Building . . Slope . . . . . . . . . . . . . . . . .. . R `V. <br /> Well . . Well . . . Perc. Rate <br /> Subdivision . . . . . . Other (Specify) . . . . . . Dry Well . . . . . . o <br /> f� Conditional Seepage Trench U\ N Cn <br /> C CD <br /> 2. Classification J��- Z_ Land Privy ) C <br /> �I 111��' 111 �TZ , ° —. <br /> Zoning Dist. . . . . . . Seepage Bed � . . .�. •''�, —• o <br /> 6. Use (describe exactly, 1 <br /> 3. Lot Size home, motel,etc.) FOR COMMERCIAL USE ° <br /> 7 <br /> ft. x ft. Plans Submitted . . . . . . A <br /> . . . . . . . . . . . . . . . . . . sq. ft. Plans Approved ' <br /> -------------------------------------------------------------------- <br /> Fig. Location of proposed structures and <br /> I C2 existing structures, well, sewage Sys- o <br /> l� tems, roads, etc., should be sketched <br /> in Fig. A. Include road setback, side :� s <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 /> them and at the intersection. <br /> :q <br /> PERMIT FEES <br /> 3�I) ig Subdivision . . . . . . . . . $15.00 �� `D <br /> Land Use . . . . . . . . . . . 1.00 <br /> Building . . . . . . . . . . . 5.00 <br /> Sanitary . . . . . . . . . . . 10.00 1 Well . . . . . . . . . . . <br /> Septic Tank . . . . . . 16.0 <br /> Combination Building, Sanit <br /> and Well . . . . . . . . 15.00 <br /> i <br /> Signature o�9 wer r Agent Date Zo g A inistrator <br /> Inspection Date f......................... Inspector / ......... tom/.. .. !s`f . ............................. <br /> Remarks .. . ....! ..4.. ........................ <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 />