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SAIL <br /> Burnett County _._ Office of Zoning Administrator m O ti r <br /> APPLICATION FOR SANITARY — LAND'.USE'— BUILDING PERMIT = A s <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a, <br /> Permit foi the work described and located as shown herein. The undersigned agrees that all <br /> work shall he 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- n c <br /> rations of the State of Wisconsin. c <br /> O <br /> race. . . acou . . _ . . . . . . _ . . . . .se< _ <br /> caner or Agent 1pleaseli,Apant) Centrad;;or Surveyor 'N <br /> O <br /> Z <br /> Address - Address <br /> G/z - 3S 3a7.7. . . . <br /> . . . . . . . . . . . <br /> Phone /1 Phone \ <br /> � <br /> J x <br /> . . . Jr . <br /> .�. .0. . � � � � � � � � � � � � . . . . . . . . . . . <br /> Plumber Well . . . . . . . . . . . . . . . . . : l <br /> 3 <br /> v : 2 <br /> . . . Address. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . it C <br /> Address tldress <br /> N <br /> - ^ o <br /> a. A ° <br /> Ph. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . q <br /> one Phone <br /> oa : <br /> o ^ a <br /> - DESCRIPTION 4. Building Details 7. Sanitary Facilities <br /> Type of C nm <br /> ttruction No. Bathroos . .(. . . z z a ?� <br /> 1. Work yy . . . . . yy�f-Q 6'm -`Z. . . Dishwasher <br /> New Building . .rt . . Size . ..1.0 ft. x .[}.tili- ft. Garbage Grinder . . . . . . <br /> Addition Height . . . . . Stories . A,oL- . Amom. Laundry <br /> Sanitaryr- <br /> . .x . . Area . . . . . . . . . . . . . . . . . . . No. Bedrooms ' <br /> Alterations . . . . . . Waste Disposal System -75d .� x EA, ° a <br /> Moving . . . . . . 5. Permits Required Septic Tank Size Gals. f�9 ` •\ (a <br /> Wrecking . . . . . . Subdivision . . Absorption Field Site T <br /> Mobile Home . . . . . . Sanitary Soil Type h. . . . . . . . . . . . . . . . . . <br /> Privy Building Pers.. . . . . . . . . . . . . . . . . . . . . N m ^ <br /> Well . . .�.�. . Well . .zl . . Rate �-• I'r'k• i1T e' <br /> Subdivision . . : . . Other (Specify) . . . . . . Dry Well <br /> Conditional Seepage Trench . . . . . . I $� mSy <br /> 2 Classification pLand . . . . . . Privy . . ay E $ a <br /> Zoning Dist. n . . . Seepage Bed ' �:/• t� :i o <br /> 6. Use (describe exactly, 1 - tam. ' U1 r—fa, <br /> 1 Lot Size home,motel,etc.) FOR COMMERCIAL USE I ° <br /> fLx 19,Q, . . , ft. Plans Submitted e0 <br /> SQ/LS dFQ EH/,4 - O Q LJ <br /> sq_ft. -- Plans Approved.___ <br /> -- ---------------L< ----- <br /> ALocation of etc.,rposed structures sketched y a� <br /> ^� Fiy. . <br /> existing structures, well, sewage sys <br /> 0 <br /> R o <br /> �5�� s•.• in Fig. A. Include road setback, side 1; zT <br /> and back yard dimension and location ;£ SN is <br /> -7;f and setback from all bodies of water. <br /> �� If property is located at a highway in- <br /> IS' <br /> n- <br /> Lr I r� PC trisection, show the intersecting high- T-V <br /> y 3 1 ways and the setbacks required along l tie E: <br /> \70 lS br 1 k Jhem and at the intersection. <br /> ' � �• ray hg t .cv [p <br /> 'S h PERMIT FEES <br /> v r It 7t�` Subdivision 515.00 <br /> Land Use . . . . . . . . . . 1.00 is fir <br /> I �r Building . . . . . . . . . 5.00 <br /> Sanitary 10.0 :F pt-c if: <br /> WeII 5, :Z `:� k. <br /> Se n1c Tank 1.00 ifs <br /> ,f,� [4 •+i 11 Combination Bu itd in g, Sanitary <br /> and Well 15.00 • <br /> ....r...Y,.Base.. J1 <br /> <'--x. .................. .7_7lL.-.77 <br /> i nae tifFof <br /> SOwner or Agent Date (/ 7b,/�in m in ist refer <br /> Inspection Date ........... ... .. " f I !..717 Inspector ../f�'F..( C?::.�ti'!�gZ....y... G-KK.L',[...(./.....-.........::...... <br /> \ Remarkl �... .. �`.. <br /> ............ ... ..z.Z.... f1'S' F.-><:.T!7:.!?il..:r'. .Z:�I.,"/A./ ll..... .s1. ..6!.r!>•c.•.Ctp...l7 .+7,`5. :.?';.� <br /> ....... ..... ...�... 1�4 ... ..6�u �44........ . _ l_S<< . ..... .......... ..... . .... . . . <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 /> SEINER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />