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e a o <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, <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regn- 1" E <br /> lations of the State of Wisconsin. <br /> t char n }G►-ai/� o <br /> Owner or Agent (pleaseprint) Contrainor or Surveyor <br /> •(� <br /> . .... . .. . . .. .. .. . .. . ... . . . . . .. .. .. ... . .. .... ........ ......... .... . — <br /> Address Address :P <br /> . .............. .... .... .... .. ... . .. ... . . . YL... ... <br /> Phone Phone � <br /> t7 :� <br /> Plumber WellDriller <br /> Address Address <br /> Phone Phone <br /> I <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities <br /> 1. Work (check one) Type of Construction No. Bathrooms . . . .. c, S <br /> Dishwasher . . . <br /> New Building Garbage Grinder <br /> � � y A <br /> Addition .. Bedrooms <br /> Santa Sft. x .� ft. Autom. Laundry .. Vv Q <br /> Alterations . ..... Height Stories ... . No. Be roo sal w <br /> Moving . .... . Area System <br /> Wrecking ...... .• •.• •... .. . ... .. . Septic Tank Size <br /> Mobile Home . .... . 5. Permits Required ` x <br /> Privy • • Subdivision � ••• Gallons r Q j <br /> .7... . /nl <br /> Absorption Field Sitq :n <br /> Type . .. . 5 c <br /> Well Sanitary �. Soil cL:" � I <br /> Subdivision . .. ... Building :y Slope . .J.. o .F . ... . . b O. a 6 <br /> Well L. .. . Perc. Rate . CYC? <br /> 2. Classification Other (Specify) . .... . Dry Well <br /> Zoning Dist. LCaondditional Seepage Trench V <br /> 3. Lot Size 6. Use (describe exactly, 1- Seepage Bed 1.d .X l•'k ;J c <br /> fam. home, motel, etc.) FOR COMMERCIAL USE <br /> ft. x .... .. . ft. 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 ;o <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 %;3 o <br /> any of the information conveyed herewith is found to exist. Changes in plans or specifics- :(b <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 />