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OIL <br /> Burnett,County - -Office of Zoning Administrator - m o Z <br /> 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 s _ <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 reign v <br /> latimn of the State of Wisconsin. c i .t. O <br /> Quentin Brandt _ l� 777"` E <br /> Owner or en <br /> Agt please Print) Contractor or Surveyor N <br /> 1201 SP. loth St. <br /> . . �Proitie .d4 .Chien, .HI . .53&2l .'. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . = x <br /> Address Address n - <br /> S <br /> Phone . . . . . . . . . . . . . . . . . . . . . . . . ._ . . . . . .Phone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i <br /> I <br /> . . Ponald Denials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . :� <br /> Plumber Well Driller <br /> Siren, WI - Yo= <br /> O <br /> . . . . . . . . . . . . . . . . . . . - �JJ <br /> Adtlress . . . . . . . . . . . . . . . . . . . . Address <br /> q o <br /> 349-5364 or 463-2333 <br /> Phone � � Phone �� <br /> o <br /> DESCRIPTION 4. Building Details7. Sanitary Facilities: O T a d <br /> Type of Construction No. Bathrooms =p c 1 <br /> 1. Work . . . .. . . . . . . . . . . . . . . . . . . . No. Bedrooms , . . . 1 1 o „ <br /> t o. = <br /> New Building . . . . . . Size . . . . . It. x . . . . . . ft. Septic Tank Size Gals. . :.ISO <br /> Addition . . . . Height . . . . . Stories . . . . . . . ... . . . ip i <br /> Sanitary . . . . . . Area . . . . . _ . . . _ . . . . . 7a.Absorption Field Site: <br /> Filling . . . . . . Soil Type . . . . . . . . . . . . . . . . . . iW o <br /> Moving . . . . . . 5. Permits Required Slope . . . . . . . . . . <br /> Grading . . . . . . Subdivision Pere. Rate .3 3* 3 <br /> . . . . . . . . . . . . . . . . . o n :\ <br /> Mobile Home . . . . . . Sanitary x . .'. Dry Well . . .. . . A <br /> Privy . . . . . . Building . . Seepage Trench . . . . . . <br /> Well Well x Privy . . . . . . <br /> Subdivision . . . . . . Other (Specify) . . . . . . Seepage Bed 12X35 o !`� e <br /> Conditional . . . . . . 420 sq ft ?� '�c to 1 <br /> 2. Classification Land Use . . . . . . <br /> �u� <br /> V c o <br /> Zoning Dist. rt <br /> `s Ta 6. Use (describe exactly, 1 -fam. <br /> 3. Lot Siee home, motel,etc.) FOR COMMERCIAL USE <br /> . . . . . . . . . ft.x . . . . .. . . it. Plans Submitted . . . . . . i�. �( <br /> . . . . . . . . . . . . . . . . . . sq. f[ Plans Approved . . . . . . <br /> -_____________________FI_A______________ :1 <br /> I <br /> 9 Location of proposed structures and <br /> existing structures, well, sewage sys- F <br /> terns, roads, etc., should be sketched (� <br /> in Fig. A. Include road setback, side- !� s <br /> and back yard dimension and location ;rD a <br /> and setback from all bodies of water. <br /> If property is located at a'highway in <br /> trisection, show the intersecting high- <br /> - ways and the setbacks required aiong <br /> them and at the intersection. '�:'(� ; <br /> t N D � <br /> PERMIT FEES V <br /> Subdivision...:.$25.00 + $2.00 per lot. " 1 <br /> Land Use................................. $10.00 <br /> �i <br /> B Id ing..............I.................... 10.00 <br /> Sanitary .._.............._r$.35..!^... -2&00 <br /> Well <br /> ...................................... 10.00 .0 <br /> Septic Tank ............................ 10.00 <br /> Privy ....................................... 5.0 <br /> t <br /> S gnah re of Owneror Aycnt - - `" - ' -0a[e Zoning Adminrstr Or - \ ` <br /> Inspection Date ................................................ Inspector , <br /> Remarks .._................ ... 1 <br /> ....... ..................................-......................................................................... <br /> ................ <br /> y , <br /> NOTE:iA preliminary site inspection must he made and site approval granted on all structures involving sanitary feeilillY <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the Percolation test must be attached t <br /> this ep Plication before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any huib <br /> tug until a permit has been.issued. A prrmit may be revoked if misrepresentation of any of the information conveyed her <br /> with is found to exist Changes in plans or specifications shall not be made viithout approval of the Zoning Administrate <br /> SEWER SYSTEM SHALL NOTBE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />