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Burnett County 'i�L� Office of Zoning Administ at r <br /> aop�_LICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> \t\ <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application fora i o <br /> Permit for the work described and located as shown herein. The undersigned agrees that all y <br /> work shall be done in accordance with the requirements of the County Zoning Ordinance, <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- a i f <br /> lati s of the State of Wisconsin. O <br /> m � <br /> KL. . . . . Gr.eq. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - Z�� <br /> Owner or A ent (please print) Contractor or Surveyor <br /> CZ` <br /> Address / Address a v <br /> c l <br /> �F <br /> t� <br /> Phone. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Phone <br /> . . . . . . . . . . . . . . . /'� <br /> Plumber I Well Driller 1 , 1 <br /> vJ <br /> O <br /> Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Address . . . . . o <br /> . . . . . . . . . . X0.43 - . <br /> 0 <br /> Phone Phone rr0 <br /> m � <br /> � o <br /> � o <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: <br /> Type of Consfrucl/en No. Bathrooms o Z .°o <br /> 1. Work . . . . . . . . ... . . . No. Bedrooms . . . o �o i <br /> New Building . . . . . . Size . . . . . ft. x . . . . . . ft. Septic Tank Size Gals. <br /> Addition . . . Height . . . . . Stories . . . . . . <br /> Sanitary . . d�. . . . . . . . . . . . . . . . <br /> Area 7a.Absorption Field Site: \� <br /> Filling . . . . Soil Type o <br /> e <br /> Moving . . . . . . 5. Permits Required Slope . . . . . . . . . . . . . . . . . . . . <br /> Grading . . . . . . Subdivision Perc. Rate . . . . . . . . . . . . . . . . . . :a <br /> Mobile Home . . . . . . Sanitary L.- Dry Well m <br /> . . . . . . <br /> Privy . . . . . . Buildiny . , . _ . . Seepage Trench . . . . . . `° i iT <br /> Well . . . . . . Well . . . . . . Privy i" i ia1 <br /> Seepage Bed tay <br /> Subdivision . . . . . . Other (Specify) . . . . . . <br /> Conditional . . . . . . <br /> 2. Classification Land Use . . . . . . G <br /> � w <br /> Zoning Dist. <br /> o <br /> 6. Use (describe exact) 1 - fam. ' <br /> 3. Lot Size home, motel, etc.) FOR COMMERCIAL USE o <br /> . . ft. x . . . ft. Plans Submitted . . . . . . <br /> 0. It sq. ft. Plans Approved . . . . . . i <br />----------------------------------------- ------------------------- <br /> Fig. A. Location of proposed structures and <br /> existing structures, well, sewage sys- '�' o <br /> tems, roads, etc., should be sketched <br /> in Fig. A. Include road setback, side s <br /> and back yard dimension and location ;� a <br /> and setback from all bodies of water. � <br /> If property is located at a highway in- <br /> tersection, show the intersecting high- r <br /> ways and the setbacks required along _ <br /> / them and at the intersection. <br /> y <br /> Q� PERMIT FEES <br /> r <br /> Subdivision..... $25.00 + $2.00 per lot. 1D <br /> Land Use................................. $10.00 — <br /> Building................................... 10.00 :\ <br /> Sanitary .................................. 20.00 <br /> Well ........................................ 10.00 <br /> Septic Tank ............................ 10.00 C <br /> Privy ....................................... 5.00 <br /> .....��... ................ ..........^......_..._...................... .l.O � ........ .. (. ..`,.. `Y%1 %; O"'F. �`.. �'. I ......... <br /> Signatu of Owner or Agent at Zoning Administrator <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 />