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Burnett Cqunty Office of Zoning AdministratorC N 13 0 H Z <br /> CD CD D) 0 o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT ° 3 c <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a -I - o <br /> Permit for the work described and located as shown herein. The undersigned agrees that all N p <br /> work shall be done in accordance with the requirements of the County Zoning Ordinance, c <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- -v °- <br /> lations f the State W isconsin. -, C- <br /> Owner or Agent (pleas print) Co ractor • .urveyor \\4, <br /> . . e.Wee.. . . . . . ; '",/'/2 3 cu <br /> y '� \ `�° <br /> L.,40-72e,2., <br /> a ' <br /> Address Address C- <br /> 63X33/ <br /> Phone Phone <br /> N. <br /> Plumber Well Driller <br /> Address Address (7 G) <br /> o o <br /> • <br /> O. ,-+ <br /> Phone Phone CD y I- <br /> 0 , O <br /> CD o r' <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: <br /> Type of Construction No. Bathrooms o z 0 <br /> 1. Work No. Bedrooms ° m <br /> New Building Size ft. x ft. Septic Tank Size Gals. < <br /> Addition Height Stories <br /> Sanitary Area 7a.Absorption Field Site: <br /> .SI— <br /> Filling <br /> Filling Soil Type o <br /> Sloper-. <br /> Moving 5. Permits Required <br /> Grading Subdivision Perc. Rate <br /> Mobile Home Sanitary Dry Well 11 CD <br /> Privy Building Seepage Trench fD CD <br /> Well Well Privy ' <br /> Subdivision . .e....1<-:- Other (Specify) Seepage Bed o ( <br /> Conditional W cn cn <br /> C CD <br /> 2. Classification <br /> �� / Land Use <br /> Zoning Dist. a o <br /> 6. Use (describe exactly, 1 -fam. ( �' <br /> 3. Lot Size home, motel, etc.) FOR COMMERCIAL USE o spy 3 <br /> ft. x ft. Plans Submitted <br /> sq. ft. Plans Approved <br /> _ 1 <br /> Fig. A. Location of <br /> proposed structures and 4—I <br /> existing structures, well, sewage sys- —o <br /> tems, roads, etc., should be sketched 4`'* <br /> in Fig. A. Include road setback, side '1= <br /> and back yard dimension and location ©'O 0,0-O. <br /> and setback from all bodies of water. `, <br /> If property is located ata highway in- <br /> /� tersection, show the intersecting high- Q)p <br /> ways and the setbacks required along C3 ©4 <br /> ,../ify <br /> ,� them and at the intersection. <br /> p...i, 6 <br /> PERMIT FEES `� y, . <br /> Subdivision $25.00 + $2.00 per lot. U 9_1 <br /> Land Use $10.00 <br /> Building 10.00 <br /> Sanitary 20.00 <br /> Well 10.00 <br /> Septic Tank 990/5- <br /> . <br /> Privy 5.00 <br /> Signature of Owner or Agent 4. Zt <br /> e Zonin. • •ministrator <br /> Inspection Date Inspector <br /> Remarks <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 />