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Burnett County – Office of Zoning Administrator o <br /> CD CD CU o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT -o <br /> 0 <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 a) y -, w <br /> work shall be done in accordance with the requirements of the County Zoning Ordinance, x- CD3 <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- - a � <br /> C ` <br /> lationssoof the State of <br /> Wisconsin. I -CD a ' .n o <br /> 1 <br /> Owner or Agent (please print) Contractor or Surveyor N 1 <br /> - c <br /> - <br /> c. <br /> Address Address <br /> :1- v <br /> J r�1 <br /> Phone Phone <br /> T <br /> /V) /-1. ey7 17---/4 c _ il <br /> Plumber Well Driller '}k <br /> Address Address m G) <br /> n 0 ' <br /> h , <br /> o <br /> Phone Phone CD a <br /> CD o 401 <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities 1ia p <br /> Type of Consiru,ctiop No. Bathrooms Z zo T <br /> 1. Work —xis h Dishwasher o 0 <br /> New Building Size ft. x ft. Garbage Grinder ,- (/' <br /> AdditionHeight Stories Autom. Laundry <br /> Sanitary . . Area No. Bedrooms <br /> Alterations Waste Disposal System i_14....: 7., o <br /> Moving 5. Permits Required Septic Tank Size Gals. -'Z.Y/AT i/1 , G <br /> Wrecking Subdivision Absorption Field Site Cir („ <br /> 71 m <br /> Mobile Home Sanitary Soil Type CD <br /> CD i' <br /> CD Privy Building Slope CDEft <br /> Well Well Perc. Rate ,. . . <br /> Subdivision Other (Specify) Dry Well 3 - (--, 0 *NN, c")) <br /> Conditional Seepage Trench q <br /> 2. Classification Land Privy a <br /> Zoning Dist. Seepage Bed �Z• 3 <br /> 6. Use (describe exactl 1 -fam _. <br /> • <br /> 3. Lot Size home, motel,etc.) FOR COMMERCIAL USE ° <br /> ft. x ft. Plans Submitted la <br /> sq. ft. Plans Approved <br /> -F ""••.) <br /> - - <br /> Fig. A. .th„ , Location of proposed structures and O3 <br /> J Ili existing structures, well, sewage sys- G o <br /> (�S 10 tems, roads, etc., should be sketched • <br /> f to f in Fig. A. Include road setback, side _ 3 <br /> ; cj y and back yard dimension and location € <br /> and m er. <br /> If property is locatedfroall bodies at a highwayofwatin <br /> Ul <br /> tersection, show the intersecting high- 1 C <br /> Iç:iways and the setbacks required along/ q them and at the intersection. .0 ; <br /> 6 <br /> ,,, 4 0 <br /> �_ °' A ` PERMIT FEES -11 <br /> �-� � Subdivision $15.00 <br /> �j Land Use 1.00 <br /> Y BuildingIt <br /> Sanitary 10.'r <br /> V tof`�o•al� Well 5.00 <br /> / G -7.� Septic Tank 1.00 <br /> CD <br /> E. <br /> (l/� ` ( � Combination Building, Sanitary <br /> G �" and Well 15.00 <br /> j 411/ , <br /> /. p- , <br /> Signat: e of Owner or Agent Date Z ing A inistrator <br /> Inspection Date ... "/ . '% ....�/..J...........(..7.4S Inspecttor .. . .. 'F...(.4 . .tom~ <br /> Remarks . 2/..�...,2f�...P 4-';' 1,-t...- • k�%'..�''�' /,:'-, --,-, <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 />