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Burnett County Office of Zoning Administrator <br /> M mm o ° <br /> APPLICATION FOR SANITARY — LAND USE -d BUILDING PERMIT 3 <br /> 7 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application fora <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 <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- <br /> lations of the State of Wisconsin. o- :�I O <br /> Eugene R. Neubauer :^ <br /> Owner or Agent (please print) Contractor or Surveyor <br /> 137 East Page St, St. Paul, MN 55107 <br /> . . . . . . . . . . . . . . . . . . . . <br /> :r. <br /> Address Address <br /> d V , <br /> -- ` IJ :n <br /> . . <br /> Phone Phone <br /> Donald Daniels :NQ <br /> Plumb6er <br /> . ' er . . . . . . . . . . . . . . . . . . . . . . . . . . . Well Driller . . . . . . . C <br /> Box W Siren, WI 54872 \ V o <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> Address Address �Q. n 0 m o \ <br /> 349-5364 <br /> P. h. .one. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> Phone. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> N <br /> 0 <br /> 0 ° :R <br /> n �;. <br /> DESCRIPTION 4. Building Details -07. Sanitary Facilities: ° <br /> Type of Construction No. Bathrooms • . • o Z °o <br /> 1. Work No. Bedrooms ° <br /> New Building . . . . . . Size . . . . . ft. x . . . . . . ft. Septi jTank Size Gals. . . . . . . <br /> Addition . . . . . . Height . . . . . Stories . . . . . . !7�'/�)w y TR' W K <br /> Sanitary . I�l Area 7a.Absorption,Field Site: <br /> Filling . . . . . . Soil Type cushing <br /> Moving 5. Permits Required Slope <br /> Grading . . . . . . Subdivision / Perc. Rate . ./l/D)1fT. . . . . . . <br /> Mobile Home Sanitary I/, , Dry Well <br /> Privy . . . . . . Building Seepage Trench . . . . . . <br /> Well . . . . . . Well Privy . . . . . . <br /> Seepage Bed o� <br /> Subdivision Other (Specify) o <br /> Conditional . . . . . . c C <br /> 2. Classification Land Use . . . . . . : I a <br /> C <br /> Zoning Dist. . . . . . . <br /> 0 <br /> 6. Use (describe exactly, 1 -fam. H <br /> 3. Lot Size home, motel,etc.) FOR COMMERCIAL USE ° <br /> � a. . . ft. x ��� . . ft. Plans Submitted . . . . . . <br /> sq. ft. Plans Approved <br /> Fig. A. Location of proposed structures and 1 <br /> existing structures, well, sewage sys- ✓ ° <br /> tems, roads, etc., should be sketched :V \ <br /> in Fig. A. Include road setback, side :SIJ <br /> and back yard dimension and location �Q o <br /> and setback from all bodies of water. <br /> If property is located at a highway in- W <br /> tersection, show the intersecting high- <br /> Y_0 Ve ways and the setbacks required along <br /> e P !!! them and at the intersection. <br /> r <br /> r n�S PERMIT FEES LJ <br /> / G7 . . . . . . . . <br /> Subdivision $15.00 fD <br /> Land Use . . . . . . . . . . . 1.00 <br /> Building . . . . . . . . 5.0 <br /> Sanitary . . . . . . . . . . 00 <br /> Well . . . . <br /> Septic Tank . . . . . . . . %m.00 <br /> Combination Building, Sanitary <br /> and Well . . . . . 15.00 <br /> Privy . . . . . . . . . . . . 5.00 <br /> #of .... . . ................. ...7.. 7................. .caner or Agent Date Z ng A nistrator <br /> InspectionDate ................................................ Inspector ................................................................................................ <br /> Remarks ............................................................................................................................................................ <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 />