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Burnett County Office of Zoning Administrator o z <br /> m 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT -0 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 N <br /> work shall be done in accordance with the requirements of the County Zoning Ordinance, A- � a <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- -o a <br /> lations of the State of Wisconsin. , o ,' <br /> O <br /> Owner or Agent (please print) Contractor or Surveyor y Ai <br /> c <br /> nCo/VE ie 401 SsYa <br /> tU/ <br /> f'/' <br /> Address Address ,,(,- d o` <br /> .� ti <br /> Phone Phone v� <br /> 4 <br /> N. <br /> Plumber Well Driller <br /> M.; �/f <G ,L A,'Z /dry \ r <br /> o <br /> re <br /> Address Address a 0 o zn <br /> 6. 6 'J'4'o <br /> Phone Phone ,, C y I- <br /> , 0 <br /> CD O 'ti <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: <br /> Type of Construction No. Bathrooms o z 0 <br /> 1. Work ( 1 4/i7'. No. Bedrooms "� ° 0 CD <br /> New Building x Size .o?f. ft. x . . ft. Septic Tank Size Gals. l4'9.c? N. N .< <br /> Addition Height Stories \ <br /> Sanitary . .. . . Area . . ./.G ►.O. . . .., 7a.Absorption Field Site: I '`') r i <br /> Filling Soil Type S-tMvr C'lAlr 10,401 V (j o <br /> '�e - <br /> Moving 5. Permits Required Slope 1-/V <br /> Grading Subdivision Perc. Rate <br /> Mobile Home Sanitary .', Dry Well <br /> i 2 gn <br /> Privy Building , ,�(, • . Seepage Trench <br /> ill N <br /> Well Well , • . , Privy <br /> Subdivision Other (Specify) Seepage Bed . . JC. . (,,I <br /> Conditional ` cnn <br /> 2. Classification Land Use \t.tl <br /> Zoning Dist. 4-2 0<' o' <br /> �� 6. Use (describe exactly, 1 -fam. H' _ <br /> 3. Lot Size Jo AC/'ef home, motel, etc.) FOR COMMERCIAL USE 0 <br /> _ <br /> ft. x ft. / c*iiiy /fa.H a Plans Submitted <br /> sq. ft. Plans Approved <br /> Fig. A. Location of proposed structures and <br /> 71)14lfi k"l> existing structures, well, sewage sys- <br /> tems, roads, etc., should be sketched <br /> /000 in Fig. A. Include road setback, side s <br /> and back yard dimension and location -3. <br /> and setback from all bodies of water. <br /> u SE <br /> If property is located at a highway in- <br /> tersection, show the intersecting highAO <br /> - <br /> ways and the setbacks required along <br /> them and at the intersection. <br /> Dzi <br /> o PERMIT FEES <br /> Subdivision $25.00 + $2.00 per lot. CD <br /> Land Use $10.00 <br /> uilding. 10.00 <br /> Sanitary 35.00 <br /> Well .. 10.00 <br /> Privy 5.00 <br /> I <br /> eC Ai / 91tott /91/ /-e7r!' o5:2e,/t- i <br /> Signature of Owner or Agent 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 />