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C— <br /> Burnett <br /> County Office of Zoning Administrator S g <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 <br /> � ` ' <br /> all work shall be done in accordance with the requirements of the County Zoning Ordinance, ' i) <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- <br /> lations of the State of Wisconsin. V� : p <br /> ►; <br /> jerr ke /er 6era Id 6,()& ner <br /> Owner or Ag�nt (please print) Contractor or Surveyor <br /> 1, bcr --) <br /> Address Address �Z <br /> Phone Phone N <br /> W. <br /> Plumber Well Driller 5 < N <br /> 0 z <br /> Address Address <br /> S <br /> Phone Phone Pg <br /> DESCRIPTION 4. Building Details 7. Sanita • Facilities <br /> 1. Work (check one) Type of Construction No. :athrooms <br /> : '•-•... <br /> Dis washer <br /> New Building Garb. :e Grinder _` <br /> Addition Size ft. x ft. Autom. aundry <br /> Sanitary No. Bed .•ms <br /> Alterations Height . . . . Stories .... Waste Dis.' al ' <br /> MovingArea System <br /> Wrecking Septic Tan Size ,C (A <br /> Mobile Home 5. Permits Required / Gallons rn Z <br /> �'3' Subdivision (/ <br /> Absorp+on Field Site g <br /> Well Sanitary Soil w e S• Q <br /> Subdivision . Building Slope o. ti C . <br /> Well Perc. Ra p <br /> 2. Classification Other (Specify) Dry Well <br /> Zoning Dist. Conditional Seepage Tre h 1 <br /> Land Privy C <br /> 3. Lot Size 6. Use (describe exactly, 1- Seepage Bed c Q <br /> fam. home, motel, etc.) FOR CO I : -CIAL USE <br /> ftx ft. Plans Su.,mitted <br /> E: <br /> sq. 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 m ust be attached to this application before a V <br /> permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any 0 <br /> building until a permit has been issued. A permit may be revoked if misrepresentation of CD <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 />