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JBurnett County • Office of Zoning Administrator r-c o y .Z <br /> 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <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 <br /> work-shall be done in accordance with the requirements of the County Zoning Ordinance, V p� <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and reyu� v � <br /> latdIe <br /> ions of the S,,tQp to of Wisc mroun. 1 y� y p v p <br /> . L l . . . i-t i� . J y . . Q�.-t/_a"F,1✓ ^� . . .-Or or Agent (please prinll / Contractor or Surveyor ! G !'t <br /> _ _ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _ . . . . . . . _ . . . . . . . . . . . . . _ ° - <br /> Address Address ' a <br /> Phonf.j- .). . . . . . . . . . . . .. . . . . . . . . . .Phone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . —` '� <br /> 01. at . . . . . . . . . . . . . . . . . .Well Driller. . . . . . . . . . . . . . . . . . . . . . . . �. :�' i.0 <br /> Address Address <br /> 0 <br /> . . . . . . . . . . . . . . . . <br /> 0 <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> . . . p <br /> Phone Phone <br /> 0 <br /> 0 <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: <br /> Type of Construction No. Bathrooms - Z y° <br /> 1. Work . . . . . . . . . . . . . . . . . . . . . . . . No. Bedrooms ° <br /> 0 <br /> New Building . . . . . . Size . . . . . ft. x . . . . . . ft. Septic Tank Size Gals. . . . . . . . 7 <br /> Addition .. . . . . Height . . . . . Stories . . . . . . . . . . . . <br /> Sanitary . . . Area ]a.Absorp[ion Field Site: <br /> Filling . . . . . . . . . . . . . . . . . . . Soil Type . . . . . . . . . . . . . . . . . . 7 0 <br /> � N <br /> Moving . . . . .. 5. Permits Required Slope . . . . . . . . . . . . . . . . . . . <br /> . . <br /> Grading . , . . Subdivision . . . . . . Para Rate . . . . . . . . . . . . . . . . . <br /> Mobile Home . . . . . . Sanitary Dry Well T r <br /> Privy . . . . . . Building ' Seepage Trench <br /> WellWell Privy . . . . . . : <br /> . . . . . . . . . . . <br /> Subdivision Other (Specify) . . . . . . Seepage Bed . . . . . . r <br /> Conditional <br /> 2. Classification Land Use <br /> Zoning Dist a o <br /> 6. Use (describe exactly, 1 -lam. <br /> 3. Lot Size home, motel,etc.) FOR COMMERCIAL USE <br /> o <br /> . . . . . . . :. ft. x . . . . . . . . ft. - Plans Submitted . . . . . . : -2 <br /> . �,...Cz— sq. ft. Plans Approved . . :. . . )' <br /> Fig.A, Location of proposed structures and iP <br /> existing structures, well, sewage sys� C�o <br /> toms, roads, etc., should be sketched <br /> in Fig. A. Include road setback, side iv�s t <br /> and back yard dimension and location - v <br /> and setback from all bodies of water. <br /> If property is located at a highway in- :x :1. <br /> !L( toec and <br /> show the intersecting high' ib <br /> ways and the setbacks required-along � <br /> ,..� � <br /> thee m aand at the intersection. <br /> 1 I p <br /> PERMIT FEES <br /> Subdivision..... $25.00 + $2GD per lot \ m <br /> Land Use................._.............. $10.00 1 <br /> Building.............................:..... 10.00 r �I <br /> Sanitary ...... ........................... 20.00 <br /> Well ...................................._.. 10.00 <br /> Septic Tank ............................ 10.00 <br /> Privy ....................................... 5.00 <br /> Orb. o)pwner or Agent Date Zoning Admin istr r <br /> Inspection Date ..:.._ .............. Inspenor .... ..................... ._............... .:..._.........-............__........ <br /> .......... <br /> Remarks ...................................................._................... <br /> ............_...:. <br /> ............................................................................................ ...................._.................................................................. <br /> .....�.._. <br /> t <br /> .................... .............. _.._.........._.._... ........... _......_....._..._.._.._....._............._._...................... ......... <br /> NOTE: A preliminary site inspection must be made and she approval granted an 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 /> r <br /> t <br />