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d y Z <br /> Burnett County Office of Zoning Administrator °CC ^ <br /> 0 : v1 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <br /> To the Zoning Administrator: The undersigned hereby makes application for 1 �" <br /> a Permit for the work described and located as shown herein. The undersigned agrees that l <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- E <br /> lations f the State of Wisqnsm0 <br /> Owner or Agent (please print) h ontractor or Surveyor : <br /> 1. � <br /> Address /�� ✓ d ess ; <br /> .5� . .. <br /> Phonnp� Phone <br /> hone ... .. .. .. . . <br /> . .. • • •• • • <br /> . ..... ... d <br /> » � <br /> Plumber Well Duller m q <br /> e <br /> Address Address <br /> Phone Phone <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities <br /> 1. Work (check one) / Typevf Construction No. Bathrooms . .. .. , <br /> New Building Dishwasher ... .. . <br /> Addition Garbage Grinder . . ... . : A <br /> SanitarySize �.iG ft. x Autom. Laundry . ..� <br /> Alterations ••.... Height Stones No. Bedrooms o� . <br /> :::: Waste Disposal <br /> Moving Area System <br /> Wrecking • ••••• Septic Tank Size <br /> Mobile Home . .. .. . 5. Permits Required <br /> C <br /> q <br /> Privy v <br /> Subdivision Gallons <br /> Absorption Field SiteWell . .... . SanitarySoil Type SQ:WO�"'• <br /> r°drSubdivision ... ... Building Slope . . <br /> Well : <br /> Per2. Classification Other (Specify) Dry Rate . <br /> p ' y . .. . : ; Dry Well <br /> Zoning Dist. . .... . Conditional . •. .. . Seepage Trench . <br /> Land . . . . . .. . <br /> Privy <br /> 3. Lot Size 6. Use (describe exactly,C Seepage Bed / Aa 0 oy <br /> !•�1 ft. x��a' ft, fam. home motel, etc.) FOR COMMERCIAL USE <br /> Plans Submitted . .... . <br /> . .. .. .. . .. . .. .. . . sq. ft. Plans Approved ... . . . : •o <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 m ust 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 <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- <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 />