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V ,`C • � ON vOMPUTERISCANNED <br /> C,� e( Burnett County Office of Zoning Administrator 5 p <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <br /> To the Zoning Administrator: The undersigned hereby makes application for <br /> - a Permit for the work described and located as shown herein. The undersigned agrees that :r <br /> all 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. \ :o <br /> �E, (lLE� <br /> Owner or Agent (please print) Contractor or Surveyor _ <br /> Address Address :? <br /> Phone . ... i. Phone . . . . . .. . . .. .. ........ . . . . .. .. . . ... . . <br /> C..fi1�S <br /> . . . ... .. ... .. ..... .. . . . . . . . . . . . .. . . . . . . . . . ... ............. .. . . . . . <br /> Plumber ������������ Well Driller � < •_ <br /> R* 14 - <br /> Address. . . . . .......... ...... . . . . . . . .. . . . . Address. . . . . .. ... .................... .... . <br /> . . .. .............. . . . . . . . . . . . . . . . .. .. .. .. . ..... .. .. ..... .... ... . . <br /> Phone . . . . . . Phone <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities ' <br /> 1. Work (check one) Type of Construction No. Bathrooms ! :I <br /> New Building 4./�►:�. ...... Dishwasher <br /> Addition ;,• Size .�[, ft. x p Garbage Grinder c=� . <br /> Sanitary .6 . . , ft. Autom. Laundry j <br /> Alterations .. .... HeightNo. Bedrooms <br /> Stories . .. . Pbl <br /> Waste Disposal 7 <br /> Moving . .. . . . AreaSystem . . . .. . <br /> Wrecking . .. .. . " ' " " " " ' Septic Tank Size <br /> Mobile Home . .. .. .. 5. Permits Required C ; <br /> Privy �.r . .4 . . :. . Gallons w <br /> Subdivision <br /> •;f• • '`/ Absorption Field Site ; fit, <br /> Well • • • • • • Sanitary Soil t <br /> Subdivision • . . . . . Building / Slopee.. o :� . <br /> Well Parc. Rate .4'—Ile ? <br /> 2. Classification Other (Specify) Dry Well <br /> ZoningDist. Conditional . . . . . . <br /> . . . . . . Land Seepage Trench . ..... <br /> Privy <br /> 3. Lot Size 6. .se--(describe exactly, 1- Seepage Bed �Sa <br /> r. �. . ft. x . ?.`. .C, ft. fam. ho motel, etc.) FOR COMMERCIAL USE <br /> Plans Submitted . . . . . . d <br /> . . . . . .. . . . . sq. ft. Plans Approved . . . . . . <br /> NOTE: A preliminary site inspection must be made and site approval granted on all struc- :� O <br /> tures involving sanitary facilities before construction can begin. In the case of sewerage dis- <br /> posal systems, a copy of the percolation test must be attached to this application before a ; <br /> 1 <br /> permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any <br /> building until a permit has been issued. A permit may be revoked if misrepresentation of <br /> any of the information conveyed herewith is found to exist. Changes in plans or specifica- <br /> tions shall not be made without approval of the Zoning Administrator. SEWER SYSTEM <br /> SHALL NOT BE COVERED UNTIL INSPECTED BY TIES OFFICE AND APPROVED. G <br />