2015/07/07 - SANITARY - SAN - Other

Home Browse Search

I j I ' a ty y z Burnett County Office of Zoning Administrator APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT To the Zoning Administrator: The undersigned hereby makes application for a Permit for the work described and located as shown herein. The undersigned agrees that : f all work shall be done in accordance with the requirements of the County Zoning Ordinance, p Sanitation Code, and with all other applicable County Ordinances and the laws and regu- lations of the State of Wisconsin. . .. .. . . . . .. .. . . . .. .. . . . ... . . . . . . .. .. . . . .. .. .. . . . .. .. .. . Owner or Agent (please print) Contractor or Surveyor ;O` D.�9N Address . . . Address. .. . . .. .... .. .. .. .. .. . ...... .. ..... :. Phone . . . . . . . .. .... . . . .. . . . . . . . .. .. . . .. . . Phone . . . .. .. .. ... . . . . . .. .. . . . . .. . . . . . . . . . a Plumber Well Driller m <. 9 r. o S Address Address o ?%!�f-3 + Phone .. .. . . .. . . . . .... ... . Phone DESCRIPTION 4. Building Details 7. Sanitary Facilities 1. Work (check one) Type of Construction No. Bathrooms . . . . Dishwasher . . . .. . New Building ;v . .. .. .. .. . .. ... . Garbage Grinder . .. .. . Addition Size . ... . ft. x .. . . . ft. Autom. LaundryN4 ' Sanitary X. No. Bedrooms Alterations ...... Height . . . . Stories . ..• G� : :U Movin Waste Disposal g Area System 1 Wrecking ...... Septic Tank Size Mobile Home . .... . 5. Permits Required : . Gallons Privy . • ••• • Subdivision • • Absorption Field Site V Well .... . . Sanitary Soil � Subdivision . . . .. . Building Type' ; o Slope . . . . ... o 0 Other (Specify) Perc. Rate . . . . . .. . . . t+ 2. Classification • •• •• • Dry Well . . . . . . Zoning Dist. ...... Conditional Seepage Trench Land Privy . . .. 3. Lot Size 6. Use (describe exactly, Seepage Bed ft. ft. fam. orae, otel, etc.) FOR COMMERCIAL USE X .. Plans Submitted . .. .. . lSt :�. sq. ft. Plans Approved . .. .. . d NOTE: A preliminary site inspection must be made and site approval granted on all struc- tures involving sanitary facilities before construction can begin. In the case of sewerage dis- posal systems, a copy of the percolation test must be attached to this application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any w building until a permit has been issued. A permit may be revoked if misrepresentation of : o any of the information conveyed herewith is found to exist. Changes in plans or specifica- tions shall not be made without approval of the Zoning Administrator. SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED.