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L.;1 ( CC)'/(f JJ ,,- <br /> Burnett County Office of Zoning Administratorco o 1C <br /> • • co CD y 0 O-- <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT � 3 C <br /> , <br /> * ' <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a --.I '' o <br /> Permit for the work described and located as shown herein. The undersigned agrees that all r\` cu y <br /> work shall be done in accordance with the requirements of the County Zoning Ordinance, ) (FL, ` s <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- v °- <br /> la 'ons of the Sta e of Wisconsin. o O <br /> 3 0 <br /> fir+h a . . . . .a4, gar H �.� <br /> Owner or Agent (plea e pri t Contractor or Surveyor <br /> 5-3o W wand S4 � ,� � <br /> Address �� �i � � 37 Address v a t �-L <br /> Phon'e Phone 1\ 0 <br /> Plumber Well Driller ,,. } <br /> 0 <br /> Address Address ''Q , of <br /> o <br /> Phone Phone y :� <br /> CDCD 0 o <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: / -° - • <br /> Type of Construction No. Bathrooms 1 o z oo <br /> 1. Work No. Bedrooms `J ° c S . <br /> New Building Size ft. x ft. Septic Tank Size Gals. ,� '•''a '- <br /> Addition Height Stories <br /> Sanitary Area 7a.Absorption Field Site: 1- <br /> Filling Soil Type o <br /> e <br /> Moving 5. Permits Required Slope <br /> GradingSubdivision Perc. Rate <br /> Mobile Home Sanitary Dry Well \. . . . CD � `y1\ <br /> Privy Building Seepage Trench CD co <br /> Well Well Privyfa <br /> Subdivision Other (Specify) Seepage Bed o .'. <br /> %LL ;A,.9 �" Conditional \ r O c CJ <br /> 2. Classification Land Use '� 7 a <br /> Zoning Dist. �`Co o <br /> 6. Use (describe exactly, 1 -fam. �N N' <br /> 3. Lot Size home, motel, etc.) FOR COMMERCIAL USE "Y - - <br /> ft. x ft. Plans Submitted <br /> sq. ft. Plans Approved -7,j IsN <br /> .D..) T-- <br /> Fig. A. Location of proposed structures and C.)-\ -1 <br /> existing structures, well, sewage sys- o <br /> tems, roads, etc., should be sketched <br /> in Fig. A. Include road setback, side 1 SE6 <br /> 4#�Qcfi ✓/r, <br /> Pb C/ r/ ?*J and back yard dimension and location <br /> `� 6` and setback from all bodies of water. Q p <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 �"• CD <br /> Land Use /4.11 0 N <br /> Building /1 .4449$ y <br /> Sanitary o 3.0.99 <br /> Well %e) #ic904. <br /> Septic Tank 10.00 <br /> Combination Building, Sanitary <br /> and Well 4a - <br /> Privy 5.00 <br /> 1 <br /> 3 <br /> /01 ' All ' <br /> (111- A r <br /> Signature of • , ner or ent Date onin dm in istrator <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 />