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e y z <br /> Burnett County Office of Zoning Administrator o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 1 <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 /> all work shall be done in accordance with the requirements of the County Zoning Ordinance, <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and re <br /> gu- E <br /> nse <br /> o the S of Wisconsin. 7 y (C �wA Pie. . . .. . . . . .. .. . . . . . . . . . . ... : ) <br /> O er or Agent sg prin Contractor or Surveyor <br /> Address // �,�q-,fig L1 ) Address <br /> Phone , .. . . Phone <br /> . ..umb. . .. . .. . . . . .. . .... . .. . . .. . . . . ... .. . .. . . . . . . . <br /> Pler Well Driller <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 /> New Building ... .. .. .. .... .. ... . .. .. Dishwasher <br /> Addition Garbage Grinder . .. .. . <br /> Size . . . . . ft. x . . .. . ft. Autom. Laundry . .. . . . \ <br /> Sanitary No.No. . .. . . . <br /> Alterations Height . . .. Stories . .. . <br /> Waste Disposal <br /> Moving ... ... AreaSystem . . . .. <br /> Wrecking ...... Septic Tank Size e <br /> Mobile Home . .. . . . 5. Permits Required I ¢� � p yG <br /> Privy Subdivision : • Absorption Field SitaeIIu n <br /> Well . ••• • • Sanitary t� <br /> Subdivision . .. . . Soil Type . . . . . ..... . .. <br /> • o <br /> Building Slope . . . . . . . . . .. . . .. . o 0 <br /> Well • • • • • . Perc. Rate . . . . . . . . . .. . <br /> Other (Specify) <br /> y) . ... . . <br /> 2. Classification P Dry Well . .. . . . <br /> Zoning Dist. Conditional . .. . . . Seepage Trench <br /> Land . .. . . . Privy <br /> 3. Lot Size 6. Use (describe exactly, 1- Seepage Bed ."a Ri <br /> i o <br /> ft. ft. <br /> fam. home, motel, etc.) FOR COMMERCIAL USE <br /> x . ... .. . �• <br /> Plans Submitted . .. .. . <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 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 <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 <br /> SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. :�\ <br />