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Burnett County Office of Zoning Administrator Cl) o z <br /> CD CD APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT -0 30 o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a J-1 '_' o ^�G <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, J m <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- -0 a <br /> op <br /> lotions of the State of Wisconsin. 3 0- ( O <br /> Owner or Agent (please print) Contractor or Surveyor c y ` <br /> Address Address rt1 E <br /> Pii) CO 77/"ti ' ‘ .--(LIC--2/ !_°- 4.z <br /> Phone Phone : ,...12.,. 1 <br /> Plumber Well Driller 1 I <br /> Address Address �~ n <br /> Phone Phone ON o <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: ° <br /> Type of Construction ^ No. Bathrooms , o Z <br /> 1. Work . . . . .€t2 .�i'.4 --. . No. Bedrooms - o \ 3 <br /> New Building Z.Size ., ft. x .Vi . ft. Septic Tank Size Gals. .2 \ .( <br /> Addition Height . . 2. Stories . I. . . . O <br /> Sanitary . . Area . . . . . . .s 2 .. . . . . 7a.Absorption Field Site• k) •� <br /> Filling Soil Type ,$ e��D VI \ 1 ° • <br /> Moving 5. Permits Required Slope T <br /> Grading Subdivision Perc. Ratevl <br /> Mobile Home Sanitary ,)S. . Dry Well CD <br /> Privy Building k Seepage Trench 1 W `r\ <br /> Well . X . Well Privy <br /> Subdivision Other (Specify) Seepage Bed . . . . h <br /> Conditional / 8 X23 IP cn cn <br /> C CD <br /> 2. Classification Land Use \0� a n <br /> Zoning Dist. . o <br /> 6. Use (describe exactly, -fam. -. <br /> 3. Lot Size —Milne motel, etc.) FOR COMMERCIAL USE ° <br /> .1 . / � . . . ft. c�,�/n/ Plans Submitted ''. i y <br /> ,/ Sq. ft. Plans Approved <br /> Fig. A. Location of proposed structures and tA -1 <br /> existing structures, well, sewage sys- i) 0 <br /> tems, roads, etc., should be sketched 0 <br /> in Fig. A. Include road setback, side - <br /> and back yard dimension and location -15. <br /> and setback from all bodies of water. {� <br /> If property is located at a highway in- 1%4, ` <br /> tersection, show the intersecting high- \ (\ <br /> ways and the setbacks required along \ <br /> them and at the intersection. \ v <br /> c ---L� 44r. � - PERMIT FEES �J <br /> _..- Subdivision $25.00 + $2.00 per lot. � D <br /> Land Use $10.00 • <br /> Building 10.00 N <br /> Sanitary 4'7 S: cc .2443-0 NI f; <br /> Well 10.00 <br /> Septic Tank 10.00 <br /> Privy 5.00 <br /> Signature of Owner or Ag n Date Zoning Administrator <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 />