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Burnett County Office of Zoning Administrator N ci Z <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 m H1 <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- -0 ° ` <br /> lations of the State of Wisconsin. ; �) O <br /> t L �.e-€ <br /> a� T. . . . . . . . ft. Ss . . . . - . . . . . . . .e. ��. . . . QRS. . . . . . . <br /> Owner or Agent (please print) Contractor or Surveyor N <br /> 3.7 . . . . . . . . /�1. . .11 . ./�1,� . . . . . . . . . . . . . . . .Y. MM <br /> Address address <br /> o .� <br /> Phone Phone <br /> (S. e. b er . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . `) <br /> Plumer Well Driller <br /> Address Address m0 0 <br /> G) <br /> rlcl 3SZ1�' �l`� <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> Phone Phone m y m <br /> n 0 0 <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: O <br /> Type of ConstructionNo. Bathrooms . . ...Z z Z o <br /> 1. Workf'�`'� F/� No. Bedrooms cid• ° <br /> New Building h . . Size 2- ft. x . �T. . . ft. Septic Tank Size Gals. 75-V \ (4 <br /> AdditionHeight Stories �. . . . S/AZ <br /> Sanitary . ... . . Area : : • . . . , 7a.Absorption Field Site: <br /> Filling . . . . . . Soil Type . . . . . �f . . . 1 o <br /> Moving 5. Permits Required Slope . . . . . . . r3/. . . . : <br /> Grading . . . . . . Subdivision Perc. Rate ! <br /> Mobile Home . . . . . . Sanitary , Dry Well . . . . . . - -n i <br /> Privy . . . . Building Seepage Trench . . . . . . <br /> Well Well x . Privy <br /> Subdivision . . . . . . Other (Specify) . . . . . . Seepage Bed <br /> Conditional N <br /> 2. Classification �,I Land Use . . . . . . Z a <br /> Zoning Dist. y!�! t (� � o <br /> 6. Use (describe exactly, 1_-fam. <br /> P o <br /> 3. Lot Siz a EE:m:ej motel,eta) FOR COMMERCIAL USE <br /> ft. x ctQQ. ft. Plans Submitted <br /> . . . . . . .: . . . . . . . . . . sq.ft Plans Approved . . . . . .----------------------------------------------------------------- <br /> I <br /> Fig. A. Location of proposed structures and <br /> .220existing structures, well, sewage Sys- . ' o <br /> 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. .^�1 <br /> If property is located at a highway in- IV <br /> tersection, show the intersecting high- <br /> ways and the setbacks required along :n <br /> them and at the intersection. `O•tl <br /> PERMIT FEES <br /> p8 <br /> Subdivision..... $25.00 + $2.00 per lot. <br /> 30' Land Use................................. $10.00 <br /> Building................................... 10.00 C1� <br /> Sanitary .................................. 20.00 1 <br /> z4� 20 ' Well ........................................ 10.00 : z7v <br /> Septic Tank ............................ 1 �- <br /> Privy ....................................... 5.00 <br /> .......... ......... ... ..... .. ........ **'*'*'(.. * . <br /> Signature of Owner or AgeAt Date Zoni ministrator <br /> InspectionDate ................................................ Inspector ................................................................................................ <br /> Remarks ............................................................................................... <br /> ............................................................. <br /> ................................................................................................................................................................................................ <br /> ................................................................................................................................................................I............................... <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 />