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Burnett County Office of Zoning Administrator , m 9 p ' y z <br /> �»M-1 o ° <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <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 19iW <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 regu- a :� <br /> ).tions .I the State of Wisconsin. 3 a p <br /> Owner or Agent [please print) Contractor or Surveyor 'NA <br /> -� n n <br /> 02 tq . JAe ICS�nt. �� <br /> o� <br /> Address Address <br /> G-,,eev Fig <br /> . . . . . . . . . . . . . . <br /> Ph. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> Phone one <br /> . Re. T . . . . . . \ <br /> Plummberber Well Driller <br /> Address Address <br /> e \ o <br /> " n <br /> ° <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> r <br /> Phone Phone <br /> n o <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: <br /> Type of Construction No. Bathrooms o Z a <br /> 1. Work L.O�(:. . . . . . . . . . . . . . No. Bedrooms <br /> New Building . . . Size }V it. x It. Septic Tank Size Gals. .75-1 <br /> Addition r Height Stories .V :➢] <br /> Sanitary . . . Area . . . .(7...�.d.'h-. . . . ya.Absorption Field Site:pp imp ij.. <br /> Filling . . . . . . Soil Type . . . . . <br /> Moving . . . . . . 5. Permits Required Slope . . . . . . . . . . . .7:�//S <br /> .Grading . . . . . . SidAuOsion Proc. Rate . . . . . . . . . . . .one, T' :IN <br /> Mobile Home . . . . . . Sanitary . ,x.'. Dry Well . . . . . . <br /> Privy Building . .z{. . Seepage Trench <br /> Well . . Well Privy / :N 1 <br /> Subdivision . .. . . . Other (Specify) . . . . . . Seepage Bed +.f11Sq <br /> Conditional - . . . . . . r \� rn O <br /> 2. Classification land Use . . . . . . <br /> o' <br /> Zoning Dist. .h .2 <br /> i <br /> 0. Use (describe exactly, -fam. = <br /> 3. Lot Size (06. e ommotel,etc') FOR COMMERCIAL USE ° <br /> .33. ft. x . ('61:. ft. Plans Submitted <br /> . . ✓�.�.ce2E'�.'. . sq. ft. Plans Approved - . . . . . . I <br /> ----------_______________________________________________________ <br /> Fig.A. Location of proposed structures and �] ! <br /> existing structures, well, sewage sys- !� <br /> tems, roads, etc., should be sketched <br /> in Fig. A. Include road setback, side <br /> and back yard dimension and [.cation ;� a <br /> and setback from all bodies of water. :\r <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 /> cSLU!'F� PERMIT FEES <br /> Subdivision..... $25.00 + 5200 per lot. .^;I <br /> Land Use................................ S10.00 <br /> ..................... ........... 10.00 <br /> Sanitar .fi S,ea X0.00 <br /> I <br /> Well ....... ............................ 10.00 <br /> ' <br /> Septic Tanknk ..............'............: 10.00 c <br /> Privy ............._........................ 5.00 t <br /> n rl <br /> S lgnamre of Own r Agent Date Zoning Admin iso.tor <br /> InspectionDate ........... ....................... ............ Inspe nor ................................... _................................................�..: <br /> Remarks .._..:....................... ............................................................................................................................. <br /> ............................. .................................................................................................................................................................. <br /> ...._......................_.............. _..... ...........:..................................................................................................._............. ........ <br /> NOTE: A preliminary site inspection must be made and site aPrrovel granted On all slructwes involving sanitary facilities <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached le <br /> this application before a permit will be issued. D° not Purchase or install a septic tank, do any plumbing or stail 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 In exist. Changes in plans or specifications shall not be made witliout.approval of the Zoning Administrator <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />