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goo <br /> Burnett County Office of Zoning Administrator <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT M <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 <br /> all work shall be done in accordance with the requirements of the County Zoning Ordinance, p <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- <br /> lations of the State of Wisconsin. y <br /> Owner or Agent (please print) Contractor or Surveyory <br /> .. . ... . .. .. .. .. ..... . ... . ... .... .. . 0 <br /> Address Address <br /> SL'R. r-6 jt�- ... . ...... .. .. .. .... .... .. .. .... .. . . . . . . . . . <br /> PhonPhone <br /> Plum Well Driller.. ... . .. .. . . . . . . ... . . . .. . . . . . . . �• <br /> rr <br /> Address y Address <br /> Phone Phone <br /> DESCRIPTION 4. Building Details i. Sanitary Facilities :ham <br /> 1. Work (check one) Type of Construction No. Bathrooms �. . S• :� ` <br /> �tJ <br /> New Building .A,"7 i� Dishwasher <br /> x. . ... . . . . . . .. .. . <br /> Addition ...... P Garbage Grinder <br /> •,,�, Size �: ft. x�. ft. Autom. Laundry <br /> Sanitary . ..L.. <br /> No. Bedrooms <br /> Alterations ...... Height Stories ..J <br /> Waste Disposal <br /> Moving . .... . <br /> Wrecking Area ... ... . . . .. . . . . . . . System � <br /> g • ••••• Septic Tank Size <br /> Mobile Home . .. ... 5. Permits Required y !� <br /> ?. Gallons <br /> Well Subdivision • •• •• • Absorption Field SiteJ ' <br /> Sanitary Soil Type . . .5. : c r / <br /> Subdivision Building Slope <br /> Well h . Pere. Rate . . . /. . . . ; <br /> 2. Classification Other (Specify) Dry Well 3 <br /> Zoning Dist. . .. ... Conditional Seepage Trench _ <br /> Land .. . . . privy .. . . 70i (\I <br /> 3. Lot Size 6. Use (describe exactly, CIL, Seepage Bed A!"V* <br /> �1 0 <br /> �! ft. faro. ome, motel, etc.) FOR COMMERCIAL USE <br /> ft. x :u. <br /> Plans Submitted . .. .. . <br /> . . . .. . . . . . . .. ... . sq. ft. Plans Approved ro <br /> NOTE: A preliminary site inspection must be made and site approval granted on all struc- <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 /> permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any T1\ <br /> building until a permit has been issued. A permit may be revoked if misrepresentation of �" O <br /> any of the information conveyed herewith is found to exist. Changes in plans or specifica- :N : G <br /> tions shall not be made without approval of the Zoning Administrator. SEWER SYSTEM :• All, <br /> SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br /> V <br />