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Burnett County .. Office of Zoning Administrator o H z <br /> CD CD a) o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 `� 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a H '' who <br /> Permit for the work described and located as shown herein. The undersigned agrees that all a, ' - <br /> work shall be done in accordance with the requirements of the County Zoning Ordinance, ,r CD lJ\\ <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- - <br /> lations of the State of Wisconsin. 3• a <br /> 1 . I .C. 1. .L. . . . . I-.•. . . . .A. l .k1 .IDS. 1 I S. 1 r L� CD <br /> Owner or Agelt (please print) Contractor or Surveyor ,i , <br /> J <br /> / �� U O !` E. `�� ,J E , was. S ` a t 7. <br /> Address Address a <br /> w <br /> Phone Phone <br /> N. <br /> .D <br /> Plumber Well Driller <br /> 0 <br /> Address Address G) <br /> 0 o <br /> o <br /> Phone Phone CD y <br /> C 0 <br /> 0 - <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: <br /> Type of Constryction No. Bathrooms 'k o z <br /> 1. Work FRAM rL No. Bedrooms ' • o <br /> New Building . .V. . Size t b� ft. x N Q ft. Septic Tank Size Gals. <br /> Addition Height 9 Stories I 1/4p\ <br /> Sanitary Area . .kR!}Q . f4,, FT, 7a.Absorption Field Site: 1- <br /> Filling Soil Type o <br /> e <br /> Moving 5. Permits Required Slope <br /> Grading Subdivision Perc. Rate <br /> Mobile Home ! Sanitary Dry Well CD Co <br /> Privy o-' Building �/ Seepage Trench Co CD <br /> Well Well Privy try <br /> Subdivision Other (Specify) Seepage Bed o <br /> Conditional o \", rn rn <br /> 2. Classification Land Use C. h <br /> Zoning Dist. "R-.' o_ <br /> 0 <br /> it'1 6. Use (describe exactly, 1 -fam. _. <br /> 3. Lot Size home, motel, etc.) FOR COMMERCIAL USE o <br /> o <br /> . .f2.5. . ft. x .3.O.p. . ft. Plans Submitted <br /> . . . . . ,3`,.S QO. . sq. ft. Plans Approved 0 <br /> Fig. A. Location of proposed structures and <br /> � existing structures, well, sewage sys- o <br /> Al''• tems, roads, etc., should be sketched o <br /> in Fig. A. Include road setback, side 3 <br /> 5°� and back yard dimension and location <br /> and setback from bodieer. <br /> RR� I If property is locatedall at a hs ighwofwayat in <br /> • / -- -- tersection, show the intersecting high- <br /> ! �¢y ways and the setbacks required along -=i <br /> 4,4 -AZS them and at the intersection. <br /> PERMIT FEES <br /> 4,0 * Subdivision $25.00 + $2.00 per lot. <br /> cp <br /> Land Use $10.00 <br /> _ tr uilding 10.00 ' <br /> 0 ./- tor El Sanitary 35.00 <br /> CA61 4 10.00 <br /> ,e 0/.4. <br /> g.,‘,../ el <br /> r 9f,mt,/a /9,/ . )- a e crae-e4-144) <br /> Signatu e o 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 he made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />