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P"7 ---- <br /> Burnett County Office of Zoning Administrator l o f <br /> � APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <br /> To the Zoning Administrator: The undersigned hereby makes application for ;' a <br /> I : <br /> a Permit for the work described and located as shown herein. The undersigned agrees that <br /> all work shallbedone in accordance with the requirements of the County Zoning Ordinance, G <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- <br /> lations of the State of Wisconsin. <br /> .. ....... . <br /> � .«�rtk � <br /> Owner or Agent(please print) Contractor.�1 *.or Surveyo. r .. . <br /> .......... . .......... ... ..... .. ........ ......... .... . <br /> Address Address <br /> ....... .... .... .... .... .. .... .... .. .. . .. . . <br /> Phone . Phone <br /> L�.....Nr - ?.... . .. .... .... r on <br /> Plumber Well Driller < <br /> .. .... .... ............. ....ress...... ........ .. .. ....... . ... .... .... . <br /> s QJ <br /> Address Add <br /> Y. <br /> . ............ ..... ... .... ....... ........ .. .P.. ... .. ... ... .... .... ........... .... .... . s� <br /> Phone hone 19 <br /> x S <br /> DESCRIPTION 4. Building Details i. Sanitary Facilities Z <br /> th <br /> B <br /> N <br /> ti <br /> t <br /> f C <br /> Type of - o. Bathrooms 1. Work (check one) T ""I• ' <br /> L� Fro ,.,v, -� Dishwasher — <br /> New Building ...... ••-• - - Garbage Grinder '[4 ' <br /> Addition j Size . a ft. z y fl. Autom. LaundryC <br /> F/ <br /> Sanitary No. Bedrooms ... � <br /> Alterations- .... Height ... . Stories .... Waste Disposal S � <br /> Moving ..... <br /> Wrecking ...... <br /> Area . .... ... . .... ._.. . ... .n <br /> Septic Tank Size ' <br /> e <br /> Mobile Home 5. Permits Required <br /> � <br /> � 0 .4..n.Gallons <br /> 0 <br /> Privy Subdivision Absorption Field SitEWell Sanitary <br /> / Sll <br /> Subdivision Type <br /> Building . ......... .. . 9 <br /> Well � o <br /> Rate . . <br /> 2. Classification Other (Specify) ....I . Dry Well ..... . <br /> Zoning Dist. ...... <br /> - <br /> d- <br /> Conditional . ... . . <br /> Seepage Trench <br /> Land . ... Privy ._... <br /> La .b ._ <br /> 3. Lot Size 6. U ribe exactly, I. Seepage Bed �j <br /> tam. home, motel, etc.) FOR COMMERCIAL USE : !� <br /> ... ... . ft. x .. .... . ft Plans Submitted ... ... :4 ) <br /> ft. Plans Approved ..... . � <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 • - � 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 THIS OFFICE AND APPROVED. <br />