Laserfiche WebLink
Burnett County O#fice of Zoning Administrator <br /> rn v O -I z <br /> P <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a = 0 .0 <br /> Permit for the work described and located as shown herein. The undersigned agrees that all <br /> work shall be done in accordance with the requirements of the County Zoning Ordinance, �' �c a :W <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- <br /> lations of the State of Wisconsina <br /> k C <br /> r O <br /> „ �, . . . . . . . . . �Cv�e. •. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> Ow or Agent (please print) Contractor or Surveyor <br /> C <br /> ,33a . .R�.�. .I. . . . .V. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> Address Address 3_.1j a <br /> . . . . P. . � : . . . 5. . . 116 . . . . . . . . . . . . . . . . . . . . . . . . . . . � --- <br /> Ph . . . . . . <br /> one Phone <br /> "Q <br /> . 5.l . . . . . . . . . . . . . . . . . . . . . . �� <br /> Plumbe Well Driller . . . . . . <br /> O <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . � . -• <br /> Address Address <br /> 8f <br /> w o c <br /> . . . . . . . . . . . . . <br /> Phone Phone N <br /> � 0 o <br /> o <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: ' ° <br /> Type of Consj;wkion No. Bathrooms • • • • • • o z �° <br /> 1. Work -@.x!$. 17.g No. Bedrooms �!• ° <br /> New Building . . . . . . Size . . . . . ft. x .U. . . . ft. Septic Tank Size Gals. . . . . . . <br /> Addition / Height . . . . . Stories . . . . . . ��SQ <br /> Sanitary //. 7a.Absorption Field Site: ro � <br /> Area <br /> Filling Soil Type . . . . . . . . .nth (J1 :C o <br /> A <br /> Moving . . . . . . 5. Permits Required Slope <br /> Grading . . . . . . Subdivision Perc. Rate . . . . . . . . . . . . . . . . . :x <br /> Mobile Home . . . . . . Sanitary Dry Well . . . . . . �. <br /> Privy . . . . . . Building Seepage Trench . . . . . . <br /> Well . . . . . . Well-71y•g°y0, C/, Privy v� <br /> Subdivision Other (Specify) Seepage Bed 1 3W�� 1 <br /> Conditional . . . . . . En N <br /> c m <br /> 2. Classificationpub Land Use . . . . . . a <br /> Zoning Dist. !. . .K � z o <br /> 6. Use (describe exactl , 1 -fam <br /> 3. Lot Size, �0 xl t� home, motel,etc.) FOR COMMERCIAL USE ° <br /> AA Q . . . x . . . . . . . . ft. Plans Submitted . . . . <br /> . . . . . . . . . . . . . . . . . . sq. ft. Plans Approved . . . . . . I ?\ <br /> ----------------- -------- ----------------------- i <br /> Fig. A. Location of proposed structures and �7 <br /> existing structures, well, sewage sys- 0 <br /> tems, roads, etc., should be sketched D ° <br /> in Fig. A. Include road setback, side s <br /> pp+(� and back yard dimension and location <br /> and setback from all bodies of water. <br /> If property is located at a highway in- :7 <br /> tersection, show the intersecting high- <br /> V” <br /> igh-V °e ways and the setbacks required along :? <br /> `Y �4� them and at the intersection. <br /> PERMIT FEES <br /> C\y Subdivision.....$25.00 + $2.00 per lot. D <br /> Land Use................................. $10.00 <br /> Building................................... 10.00 <br /> ---- — anitar ...................... Ssoo.. @9 :� <br /> Well ........................................ 10.00 <br /> Septic Tank ............................ 10.00 <br /> Priv <br /> -13S•" <br /> L � <br /> Q ...... ............ .. ... a..P,../.P.. /..... <br /> ignature of Owner or Agent e7- Date Zoning Adm in is ator <br /> InspectionDate ................................................ Inspector ................................................................................................ <br /> Remarks ................................................................................................ <br /> ............................................................ <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 /> A <br />