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Burnett County Office of Zoning Administrator ! 'f <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT CD 3 CD o ° <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a N 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, 77 M I <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- <br /> a .E <br /> lations of the State of Wisconsin. CD <br /> O <br /> _ <br /> ;,rer Agent (please print Contractor or' veyor yID <br /> CD <br /> D-aidUde4ss <br /> . . . . . . . . . . . . . . . . . . . . . . . . .ress a <br /> . . . . . . . . . . . . . CD <br /> Phone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . fD : <br /> Phone <br /> Plumber ^� <br /> Well Driller ' <br /> Add <br /> . . .ress. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> Address �' O <br /> n o <br /> 0 <br /> Phone -Pho . . . � ° <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> Phone C H r- <br /> � <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: <br /> Type of Construction No. Bathrooms z z o <br /> 1. Work �{,(g o o <br /> lip• • A �• • . . . No. Bedrooms i�.. . J o 0 <br /> New Building . . . Size . . . . . ft. x . . . . . . ft. Septic Tank Size Gals. 2—U0P <br /> Addition k . Height .9. . . Stories . ./. . . • • • , • • <br /> Sanitary . . . . . . Area . . . . YC 54' ,t-2 . . 7a.Absorption Field Site:_70. ' <br /> Filling . . . . . . Soil Type 0 <br /> Moving . . . . . . 5. Permits Required Slope <br /> Grading . . . . . . Subdivision • • • • • • Pere. Rate <br /> Mobile Home Sanitary • • . • Dry Well �. . . m t� <br /> Privy . . . . . . Building , • Seepage Trench . . . . . . M CD � k' <br /> Well . . . . . . Well . . . . . . Privy <br /> % n <br /> Subdivision Other (Specify) Seepage Bed . . . . . . :U! <br /> O <br /> Conditional . -,C N <br /> 2. Classification s� Land Use 0 s . CD <br /> Zoning Dist. .�� �T'' �:_ '+• <br /> 6. Use (describe exactly, 1 fam. 0 <br /> N <br /> 3. Lot Size home, motel,etc.) FOR COMMERCIAL USE <br /> 6yo. . : ft. x .1,00 . . ft. �/�� /�C�(�/� Plans Submitted . . . . . . 3 <br /> . . . . . . . . . . . . . . . . . . sq. ft. X �r— Plans Approved J <br /> ----------1� -------------------------------- <br /> Fig. A. Location of proposed structures and <br /> YCz4tl existing structures, well, sewage sys- o <br /> tems, roads, etc., should be sketched <br /> in Fig. A. Include road setback, side 3- <br /> and back yard dimension and location <br /> and setback from all bodies of water. <br /> j/� 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 /> Subdivision . . . . . . . . . $15.00 fD <br /> 3© ®RYA Land Use . . . . . . . . . . . 1.00 <br /> Building . . . . . . . . . . . 5.00 <br /> Sanitary . . . . . . . . . . . 10.00 <br /> Well . . . . . . . . . . . 5.00 <br /> Septic Tank . . . . . . . . . 1%0 <br /> Combination Building, Sanitary <br /> TAAU/4 and Well . . . . . . . . 15.00 <br /> Privy . . . . . . . . . . . . 5.00 <br /> Ow e.4 h p <br /> �. c�J..��':V... ..... ..�l�,j .. . a. . .... ... .. .. �...... <br /> aX t Date/ Zo g Ad i istrator <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 /> if 3 0 <br />