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t o 0 <br /> Burnett County Office of Zoning Administrator <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 /> all work shall be done in accordance with the requirements of the County Zoning Ordinance, i �' p <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- <br /> lations of the State of Wisconsin. y <br /> Q TI. <br /> . . . . . . . . .. . . <br /> y4r�Q�w S�i...... ...... . .. . . . . .. .. .. ... . .. .. .. . . . ... . <br /> Owner eh Agent (please print) Contractor or Surveyor <br /> GTA Al. <br /> Address <br /> Phone Phone <br /> tv <br /> Plumber �7 Well Driller � <br /> 5.. .a?/.5�'fr���. . .. .. .. .. .. . . .. . . .. . . . . . . . .. ... . .. . <br /> Address Address <br /> Phone Phone <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities <br /> 1. Work (check one) / Type of Construction No. Bathrooms : :/. :: : S <br /> New Building . . Dishwasher <br /> F�'''�" P'' ' ' ''' Garbage Grinder . . . .. . <br /> Addition �, yy <br /> Size ol4. . ft. x .`'w ft. Autom. Laundry . .. .. . Cn <br /> Sanitary Y.. • No. Bedrooms S <br /> Alterations ...... Height . .. . Stories (... <br /> Moving Waste Disposal <br /> g , .,,,, Area .. . . .. . . . .. . . . . . . . System . . . • . . <br /> Wrecking ...... Septic Tank Size ; <br /> Mobile Home .... .. 5. Permits Required <br /> Privy Subdivision • •7.5�... . Gallons <br /> Absorption Field SiteWell <br /> Sanitary <br /> Subdivision Building v . Soil Type a, �/��/' c <br /> Slope . .. . �... . .. . o <br /> Well <br /> . . Pert. Rate . .. .�9e. .. . <br /> 2. Classification Other (Specify) ... ... Dry Well <br /> Zoning Dist. ...... Conditional Seepage Trench <br /> Land . .. . . . Privy <br /> 3. Lot Size 6. Use (describe exactly, Seepage Bed n c <br /> r2o� ft fam. home <br /> ft , motel, etc.) FOR COMMERCIAL USE V C <br /> ��G... . x Plans Submitted . . . .. . <br /> .GQ��... sq. ft. Plans Approved <br /> :-Cti c <br /> NOTE: A preliminary site inspection must be made and site approval granted on all strut- ; <br /> tures involving sanitary facilities before construction can begin. In the case of sewerage dis- <br /> posal systems, a copy of the percolation test in 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 <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 />