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Burnett C,)unty Office of Zoning Administrator 0 --1 Z <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> :O <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application fora '" o <br /> Permit for the work described and located as shown herein. The undersigned agrees that all N <br /> work shall be done in accordance with the requirements of the County Zoning Ordinance, V.: t <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- v °- e <br /> lations of the State of Wisconsin. 3 a O <br /> James Tobias <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> Owner or Agent (please print) Contractor or Surveyor <br /> 511_ Fra :ce Ave. Mpls. Mi: 55429 <br /> c <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> Address Address n -- <br /> Phone Phone <br /> Donald Da Gels <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . WellDrille.r. . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> Plumber <br /> Sire :� WI 54-72 1 0 <br /> Address . . . . . . . . . . . . . . . . . . . . . . . . .Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> 349-5364 or 463-2333 0 0 <br /> :\7 0' » <br /> Phone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Phone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> r 2 <br /> n 00 <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities- <br /> Type of Construction <br /> ZNo. Bathrooms . . . . . . z ° i <br /> N <br /> New Building . . . . . Size ft. x . . . . . . ft. Septic Tank Size Gals. ' :3j <br /> o <br /> 1. Work <br /> . . . No. Bedrooms . . . . . \; <br /> . . . . . 750. . . �\ < <br /> Addition . . . . . . Height . . . . . Stories . . . . . . . . . . . . <br /> Sanitary .X. . . . Area 7a.Absorption Field Site: # � V <br /> Filling . . . . . . Soil Type f, :� o <br /> Moving . . . . . . 5. Permits Required Slope 3 . . <br /> O i <br /> 3. . 3 . <br /> Grading . . . . . . Subdivision . . . . , . Perc. Rate . . . . . . . . . . . . . . . . . .� <br /> Mobile Home . . . . . . Sanitary _ .x, Dry Well . . . . . . N i <br /> Privy . . . . . . Building . . . . . . Seepage Trench . . . . . . <br /> Well . . . . . . Well . , X . , Privy . . . . . . _ <br /> Subdivision . . . . . . Other (Specify) . . . . . . Seepage Bed x '^ 'O <br /> Conditional . . . . . . oQ1N <br /> 2. Classification Land Use . . . . . . <br /> Zoning Dist. <br /> 6. Use (describe exactly, 1 -fam. ' <br /> 3. Lot Size home, motel,etc.) FOR COMMERCIAL USE r ° 'p } <br /> 40U , , ,ft. x , , l0U , . ft. si gle family cabi : Plans Submitted _ r <br /> . . . . . . . . . . . . . . . . . . sq. ft. Plans Approved . . . . . . i <br /> g Location of proposed structures and <br /> Fi A. <br /> existing structures, well, sewage sys- o <br /> terns, roads, etc., should be sketched <br /> in Fig. A. Include road setback, side s <br /> and back yard dimension and location a' <br /> and setback from all bodies of water. <br /> If property is located at a highway in- <br /> tersection, show the intersecting high- <br /> ways and the setbacks required along <br /> them and at the intersection. <br /> M <br /> PERMIT FEES <br /> Subdivision..... $25.00 + $2.00 per lot. <br /> Land Use................................. $10.00 \. <br /> Building................................... 10.00 :C11 <br /> ............. <br /> Well .................................I..... 10.00 <br /> Privy ....................................... 5.00 <br /> Od <br /> Signature of Owner or Agent Date Zoning Administrator <br /> InspectionDate ............Y.................................... Inspector ................................................................................................ <br /> Remarks �1.L!!_,f7..G7.???.c .. .5.'..�:� ��.. ............................................................................................................. <br /> ................................................................................................................................................................................................. <br /> ................................................................................................................................................................................................ <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 />