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Burnett County Office of Zoning Administrator o z <br /> Co W o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 : <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 <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. 3 d O <br /> '" f� <br /> CD <br /> . .LUther. .P.oin.t, .Bible . Cam <br /> Owner or Agent (please print) Contractor or Surveyor <br /> CD <br /> Rt . 1 Grantsburg, WI 54840 a :C:: <br /> Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . a <br /> `3 :H <br /> CD <br /> 689-2347 <br /> Phone Phone :O <br /> �a :H <br /> . .Donald. .DAni:e•ls . . . . . . . . . . . . . . . . . . . . .Driller. . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> Plumber Well <br /> iren. . .WI . . . .54872 . . . . . . . . . . . . . . . . . . . . . . . . <br /> Ad ess Address o :to <br /> 463-2333 h ' <br /> Phone Phone CD <br /> 0 o <br /> o <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: z ° o } b <br /> Type of Construction No. Bathrooms • • • • • • ° o <br /> 1. Work No. Bedrooms • • • • • • fD <br /> New Building . . . . . . Size . . . . . ft. x . . . . . . ft. Septic Tank Size Gals. ;\ <br /> Addition . . . . . . Height . . . . . Stories . . . . . . • • • • • • <br /> 7a.Absorption Field Site: <br /> Sanitary . .x. . . Area . . . . . . . . . . . . . . . . . . . },� q <br /> Filling Soil Type . . . . . . . . . . . . . . . . . . o <br /> N 0 <br /> Moving . . . . . . 5. Permits Required Slope <br /> Grading . . . . . . Subdivision Perc. Rate .5 <br /> ' <br /> -n 1 :i ce <br /> Mobile Home . . . . . . Sanitary . , • , Dry Well . . . . . . CD <br /> CDPrivy . . . . . . Building • , . . . , Seepage Trench <br /> — -. <br /> Well . . . . . . Well . . . . . . Privy .Ut <br /> Subdivision y Seepage Bed p <br /> . . . . . Other (Specify) . . . • • • Cn En <br /> o <br /> Conditional . . . . . . <br /> o c CD <br /> 6 <br /> 2. Classification Land Use . • • • • . � a <br /> Zoning Dist. /7. . . .� <br /> -/ 6. Use (describe exactly, 1 - fam. o. T. <br /> 3. Lot Size home, motel, etc.) FOR COMMERCIAL USE C Lo <br /> . . . . . . . . . ft. x . . . . . . . . ft. Plans Submitted . . . . . . <br /> . . . . . . . . . . . . . . . . . . sq. ft. Plans Approved ( i <br /> ------------------------------------------------------------------ <br /> Fig. A. Location of proposed structures and <br /> existing structures, well, sewage sys- ° <br /> tems, roads, etc., should be sketched <br /> SEE STATE APPROVED PLANS in Fig. A. Include road setback, side <br /> and back yard dimension and location <br /> and setback from all bodies of water. <br /> Co <br /> If property is located at a highway in- z <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 $10.00 Co <br /> B in .............. .. .... 10.00 ;E <br /> . .......... .... : . <br /> Sanitar �S..... .... —2$@9 <br /> Well ........................................ 10.00 - <br /> Septic Tank ............................ 10.00 <br /> Privy ....................................... 5.00 <br /> .� 3 , •o..l..:... .............. ...........F.�!.................. <br /> ..... .............................. ................................ g <br /> Signature of Owner or Aglent Date Zonin Ad inistrator <br /> InspectionDate ..................................... Inspector ................................................................................................ <br /> Remarks .... J <br /> l <br /> ............. ................... .... . <br /> ................................................................................................................................................................................................ <br /> ................................................................................................................................................................................................ <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> efore construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> is application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build- <br /> until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> `is found to exist. Changes in plans or specifications shall not be made without approval of the Zoning Administrator. <br /> (EWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />