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I <br /> � O <br /> Burnett County Office of Zoning Administrator <br /> o <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 �V^\ <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 Stle of Wisconsin. m <br /> rcl.lV . 4dn'e l.. ....... . . . . .. .. . . . . .. ... ... . _ n <br /> I <br /> .. .. . ... .. .. .. . . .. .. . <br /> v <br /> Owner or qent (please print) Contractor or Surveyor <br /> Glnbcrrc .. . . . .. .. .. .. . .. . .. .... ... . .. . ... . ... .. ..... .. .. .. .. ... <br /> Address , Address <br /> ... . .. . . . . . . . . . <br /> Phone Phone : <br /> C. F <br /> Plumber Well Drlller <br /> .. . .. . . .. .. .. . <br /> ?. <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 <br /> PQ/ Dishwasher <br /> New Building <br /> "" """ Garbage Grinder . /1.Q. <br /> Addition X.. Size /a.. ft. x 2F. ft. Autom. Laundry . .. .. .. <br /> Sanitary . .. ... i No. Bedrooms <br /> Alterations ...... Height !. . Stories Waste Disposal <br /> Moving ... ... Area "2 System <br /> Wrecking . .. ... Septic Tank Size <br /> Mobile Home . .... . 5. Permits Required / �/a f�r5: Gallons o' <br /> Privy • •••• • Subdivision Absorption Field Site <br /> Well Sanitary Soil Type . A <br /> Subdivision . . . .. . Building . . Slope .. . .. . . .. .. . . .. . .� g d <br /> Well Pere. Rate . . ' <br /> Other (Specify) i p <br /> 2. Classification P y) • ••• • • Dry Well <br /> Zoning Dist. �.�.Z Conditional Seepage Trench . .. . . . h1 <br /> Land ... . . . Privy . . . .. . : <br /> 3. Lot Size 6. Use (describe exactly, 1• Seepage Bed e <br /> y6�• ft. x � T� ft* <br /> fam. home, motel, etc.) FOR COMMERCIAL USE <br /> Plans Submitted . .. ... UJ <br /> . .. . . .. .... ... . .. sq. ft. Plans Approved . .. ... <br /> .CX <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 t <br /> building until a permit has been issued. A permit may be revoked if misrepresentation of m <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 J <br /> SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. �S <br /> , <br />