Laserfiche WebLink
2 <br /> Burnett County Office of Zoning Administrator oC -Y , <br /> CD CD CD <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT ° 3 C <br /> 4. <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 d <br /> work shall be done in accordance with the requirements of the County Zoning Ordinance, a _� <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- <br /> CD ko <br /> _ <br /> lations of the State of Wisconsin. -' a � <br /> 0 <br /> ''k L.TO. it.. .6. .Y-.7►?6/2 y.'.T.1To:41s <br /> Owner or Agent (please print) Contractor or Surveyor H ` fD <br /> c <br /> CD E <br /> kOu.Te / 1it C-/' 4)1 S. a c <br /> Address Address a • <br /> Phone Phone 6).C - 16 <br /> Plumber Well Driller <br /> RTh <br /> Address Address \ m Cl • <br /> h o` C) <br /> o <br /> Phone Phone CD H I- <br /> C rt o n <br /> CD o <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: - . <br /> Type of Construction No. Bathrooms o z ° <br /> 1. Work No. Bedrooms o CD <br /> New Building Size ft. x ft. Septic Tank Size Gals. .� 0 <br /> Addition Height Stories N. j <br /> , <br /> Sanitary Area 7a.Absorption Field Site: . r.D : <br /> Filling Soil Type o <br /> e <br /> Moving 5. Permits Required Slope ilk <br /> Grading Subdivision / Perc. Rate N _ <br /> Mobile Home Sanitary , , 1"/. . Dry Well 71 <br /> m ' <br /> Privy ✓ Building Seepage Trench CT CT) <br /> Well Well !r Privy . . k". fa <br /> Subdivision Other (Specify) Seepage Bed o N <br /> Conditional cn rn <br /> CD c <br /> 2. Classification Land Use 6 h <br /> Zoning Dist. WI' <br /> a o <br /> 6. Use (describe exactly, 1 -fam. 'H <br /> 3. Lot Size home, motel,etc.) FOR COMMERCIAL USE A:VLS' <br /> //�� e� <br /> ft..�x��'' ft. Plans Submitted .� <br /> /6 akkee,. . . sq ft. Plans Approved _ Q� <br /> Fig. A. • <br /> Location of proposed structures and I • <br /> existing structures, well, sewage sys- o <br /> tems, roads, etc., should be sketched <br /> _ <br /> in Fig. A. Include road setback, side i <br /> and back yard dimension and location i 13' <br /> and setback from all bodies of water. 1 <br /> ram. 4'r. If property is located at a highway in- s�`J <br /> , , <br /> Pi' <br /> tersection, show the intersecting high- ` <br /> er P gf✓Y ways and the setbacks required along <br /> IG them and at the intersection. <br /> • m <br /> PERMIT FEES <br /> Subdivision $15.00 fD <br /> Land Use 1.00 <br /> '..., <br /> i401,4 Building 5.00 <br /> �/C Sanitary 10.00 <br /> I ��i'l' Well 5 01 <br /> 1 Septic Tank ii <br /> !10 <br /> r 1 Combination Building, Sanitary <br /> and Well 15.00 <br /> r Privy 5.00 <br /> o�-v <br /> Signs re of Owner or Agent Date oni Administrator <br /> ,,,,,,a,,,,g, <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 he made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />