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Burnett.County Office of Zoning Administrator <br />APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <br />TO THE ZO,,IING ADMINISTRATOR: The undersigned hereby makes application for a <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, <br />Sanitation Code, and with all other applicable County Ordinances and the laws and regu- <br />lations of the State of Wisconsin. <br />Hartkey M. Hedberg <br />Owner or Agent lease print) Contractor or Surveyor <br />441 Rose Place <br />Roseville„ .]IN .... <br />Address Address <br />612-484-6821 <br />one /'� a�, &s.� <br />................ ........................................ <br />PhPhone <br />Donald Daniels <br />.............................. .... .. ............................. <br />Plumber Well Driller <br />Siren, WI <br />.......................... <br />Address Address <br />349 -AA" 463-2333 <br />53 6t. <br />..........................one.................................. <br />Phone Ph <br />DESCRIPTION <br />4. Building Details <br />7. Sanitary Facilities: <br />Type of Construction <br />No. Bathrooms <br />1. Work <br />...... ............. <br />No. Bedrooms <br />New Building <br />Size . 0. ft. x . jQ ft. <br />Septic Tank Size Gals. <br />.O <br />. %,5 . . <br />Addition <br />Height ..... Stories ...... <br />Sanitary <br />X:.. <br />Area ................... <br />7a.Absorption Field Site: <br />Filling <br />Soil Type .................. <br />Moving <br />'r <br />h ... <br />5. Permits Required <br />Slope .................... <br />Grading <br />...... <br />Subdivision ...... <br />Perc. Rate ................. <br />Mobile Home <br />...... <br />Sanitary <br />Dry Well <br />...... <br />PrivyBuilding <br />Seepage Trench <br />...... <br />Well <br />%� .. <br />Well, , , <br />Privy <br />...... <br />Subdivision <br />...... <br />Other (Specify) . , .... <br />Seepage Bed <br />/ -Z X-3. 5 <br />Conditional ...... <br />41,20 <br />2. Classification <br />Land Use ...... <br />Zoning Dist <br />ME <br />T <br />CD <br />CO <br />P <br />�`• <br />6. Use (describe exactly, 1 - fam. <br />3. Lotze 225 home, motel, etc. FOR COMMERCIAL USE <br />......... ft. x ........ ft. Plans Submitted ...... <br />.... sq. ft �'n/t/� �+'�� Plans Approved <br />''% PP ...... <br />--------------------- <br />---------------Location of---------------- <br />1je6t C -p1 CTC�1/f' Fig. A. <br />proposed structures and <br />140 existing structures, well, sewage sys- <br />�// a tems, roads, etc., should be sketched <br />in Fig. A. Include road setback, side <br />and back yard dimension and location <br />a and setback from all bodies of water. <br />If property is located at a highway in- <br />tersection, show the intersecting high- <br />ways and the setbacks required along <br />them and at the intersection. <br />PERMIT FEES <br />\J Subdivision..... $25.00 + $2,00 per lot. <br />Land Use ............... $10.00 <br />.................. <br />Building ................................... 10.00 <br />Sanitary .................................. 20.00 <br />Well........................................ 10.00 <br />Septic Tank ............................ I.*ft <br />Privy....................................... 5.00 <br />