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Burnett County s - ,—Offi:e of Zoning Administrate L as " -e 0 1 Z - <br /> APPLICATION FOR SANITARY LAND USE — BUILDING PERMIT _3 F <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for _ 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, [ ib <br /> Sanitation Code, and with all other applicable County Ordinancesandthe laws and read- <br /> lations of the State of Wisconsin. <br /> lYY/ / <br /> / IiC YN4S rtt FT . . <br /> . .S . . . . . . . . . . —' <br /> Owner or Agent (please Prim). - _ Contractor or Surveyor '^ <br /> .21o3y �t,. L S`j �I (( 3b ` 5'apo n <br /> -1 <br /> Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Address . . . . . . . .�j. . . . . .� .0 . 3 . .�.J,rnt <br /> CC Eo <br /> Phone � Phone <br /> Flo b r � . . . . . . . . . Well D 'ller. . . . . . . . . . . . .. _ � :� <br /> i`U O <br /> Address :�— <br /> y o �, <br /> W 'F N-. /. . .l.0. it m o <br /> Phone . .Phone . . . . . . . . . . Xs i r <br /> o <br /> 0 <br /> DESCRIPTION 4. Building Details ? v' <br /> 7. Sanitary Facilities: <br /> Type of Construction No. Bathrooms Z ° <br /> 1. Work . . . . . . - No. Bedrooms :. . . . G <br /> New Building . . . . . . Size . . . ft. x . . . . . . ft, Septic Tank Size Gals. . 7.S J 0 � <br /> Addition Height . Stories . . . . . . - :� <br /> Sanitary � _4� Area . . . . . . . . ... . . . . . . . . . 7a.Ab5orption Field Site: <br /> o <br /> Filling . . . . . . Soil Type . . . . . . . . . . . . . . . . . . .N � o <br /> an <br /> Moving . . . . . . 5. Permits Required Slope '" » <br /> Grading Subdivision Pere. Rate . . . . . . . . . . . . . . . . . <br /> Mobile Home Sanitary !.�� Dry Well . . . . . ' 't7 <br /> Privy Building Seepage Trench <br /> Well Well Privy qq y N iT <br /> Subdivision . .. . Other (Specify) _ .. . . Seepage Bed 0.<t-�� <br /> Conditional . . . . . . - 10 i� w rn <br /> 2. Classification c <br /> c <br /> Land Use . . . . . . :r <br /> Zoning Dist. pLl� � o <br /> 6. Use (describe exactly, 1 - tam. <br /> 3. Lot Size _ home, motel,etc.) FOR COMMERCIAL USE ^ ° <br /> 1. 7. . ft. x .a.9. r . rt. n Plans Suhm ltted \ <br /> . --- . . . . . -- . . sq. ft - � Plans Approved <br /> N y u <br /> Fig. A. Location of proposed structures and <br /> t existing structures, well, sewage sys : :A o <br /> � N teens, roads, etc., should be sketched - o <br /> J in Fig. A. Include road setback side ` T <br /> I and back yard dimension and locations n <br /> and setback from all bodies of water. !(� <br /> 4 <br /> If property is located at a highway i ig -'Jt- <br /> trisection, <br /> trisection, show the Intersecting high <br /> .ways and the setbacks required along <br /> 1,07 them and at the intersection. <br /> rDay> <br /> weld � PERMIT FEES <br /> Subdivision.._. 525.00 + 5200 per lot <br /> v <br /> Land Use........................... _... S10.00 <br /> Bu dining......................... ......... 10.00 <br /> annary .. .._. 35.00 C <br /> ......._....................__....... 10.00 <br /> Privy _.................................._, 5.00 <br /> n .N3sr vs <br /> Si e o Owner or gent � ate Zoning Admin sifeto , <br /> Inspection ate lnspector _ .. <br /> Remarks <br /> ........._:. . ............. _.___......... ..........._..._. .. ........ ........._ ....._ ...................... ....._:.........._ <br /> ........_.... <br /> ................ _........ .._..... . ............... .. ........._._.. .. ._......... ......._.................... <br /> NOTE: A preliminary site inspection most 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 rest 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 anybuld <br /> - <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 /> C-1'S Y T�- <br />