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Burnett County Office of Zoning Administrator N o z <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT c 3 I o <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, x c <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- v <br /> lations of the State of Wisconsin. a <br /> o <br /> Owner. r . ./� please . . . . . . . . . . . . . . . . . . y' . . . . . . . . . . . . . . . . . . . <br /> Owner or Agent (please print) Contractor or Surve or N ' <br /> wE . . vt�1S . . . . . . . . . . . . . . . . . . . . . <br /> a <br /> Address Address <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Phone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> Phone <br /> C�4�viiv ,aF�s0111 ik <br /> Plumber <br /> Well Driller <br /> 94. 2 wEi3srcR , .Gv/S <br /> Ad <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> Address Address <br /> n o <br /> �6.6. - . . : . . 3. . . . . . . . . . . . . . . .Pho. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> Phone ne <br /> ° o <br /> s <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: O <br /> Type of Construction No. Bathrooms J Z 0 z - .. <br /> 1. Work . . . . . . . . . . . . . . . . . . No. Bedrooms . . . . . <br /> 0 ° <br /> New Building Size . . . . . ft. x . . . . . . ft. Septic Tank Size Gals. <br /> Addition Height . . . . . Stories . . . . . . <br /> Sanitary . . Area . . . . . . . . . . . . . . . . . . . 7a.Absorption Field Site, '� NA ' <br /> Filling Soil Type . . � ! 1i :N <br /> Moving . . . . . . 5. Permits Required Slope . . . . . .;Jo. . . . . . . . . <br /> Grading . . . . . . Subdivision , , . . , , Perc. Rate ,v. . . . . . . . . . . T :(� <br /> Mobile Home Sanitary , , , , Dry Well . . . . . . '� 1 <br /> Privy . . . . . . Building . . , , Seepage Trench . . . . . . `D <br /> Well Well Privy <br /> W <br /> Subdivision . . . . . . Other (Specify) . . . . . . Seepage Bed d1l, /1 . . . . . . :Ut <br /> Conditional —7 o rn cn <br /> 2. Classification �p Land Use . . . . . . Ja. 'X35 <br /> Zoning Dist. <br /> YJ 6. Use (describe exactly, i - fam. —' <br /> 3. Lot Size home, motel,etc.) FOR COMMERCIAL USE ° <br /> . . . . . . . Q2ft//x��. . . . . . . . ft. A��J) {� Plans Submitted . . . . . . <br /> . . . .�j.r2 t"►V' �q. ft' IFA//l. 1f oME Plans Approved . . . . . . Q <br />------------------------------- <br /> rXXoUS G7---------------------- <br /> S�PT lG TANK JF/i� zz1A1. �srl�l7 Location of proposed structures and ' <br /> QQ 07'tL 2 3F0 Roots existing structures, well, sewage sys- o <br /> E terns, roads, etc., should be sketched <br /> in Fig. A. Include road setback, side T <br /> and back yard dimension and location y <br /> iQ/per 'I and setback from all bodies of water. <br /> .J��zt 7IL WIt property is located at a highway in- <br /> tersection, show the intersecting high- F 4 <br /> STEED E \ ways and the setbacks required along <br /> "Itthem and at the intersection. <br /> srEPg6b 6 0 r <br /> Iz'x 35' -,//o'a " JOO� PERMIT FEES <br /> ZZV Subdivision..... $25.00 + $2.00 per lot. <br /> I . � Land Use................................. $10.00 V\ <br /> fj• 3� . W .................................. 10.00 <br /> /—� anitary .................................. 35.00 <br /> g® Well ........................................ 10.00... :M` ^ <br /> Privy ....................................... 5.00 V <br /> bio. <br /> y" .I F_At T �0� eo <br /> W�� <br /> cU �l <br /> /21 f3oUrF "ADiff .CALSIN I <br /> .... . . .ner o........................... ............. .. .. . .... <br /> Signature of Owner or Agent ate Zoning Administrator <br /> Inspection Date ../.Q..-��{�.R..�.................... InspectorW"-LC .. ............................ <br /> --7 Remarks <br /> `.:fe. �/. ... ................................................................... <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 />