Laserfiche WebLink
a y z <br /> Burnett County Office of Zoning Administrator g <br /> 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT "' I <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 regu- <br /> lations of the State of Wisconsin. <br /> Owner or Agent (plee print) Contractor or Surveyor <br /> rr%/ ... ...... .. .. ...................... <br /> Address a�y� Address {o <br /> .. .. .. ... .... . . <br /> Phone ....... .. .. .... .... .......... .. .... Phone ; <br /> C f <br /> Plumber Well Driller ' <br /> e <br /> Address.... ... ........ ......... .... .. .... Address. .. .. . . .. . . .... .. .. .. . .. . . .... ... . . <br /> .... .. ... o <br /> Phone .... ........ ...... ................. Phone S <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities <br /> 1. Work (check one) Type of Construction No. Bathrooms S � <br /> New Building ...... •• �•i,'r�, •t'!�• • <br /> Dishwasher . ..... <br /> Garbage Grinder . ..... <br /> Addition Size PZ'!.. ft. x 3 p. ft. Autom. Laundry <br /> Sanitary • ••••• No. Bedrooms <br /> Alterations Height ..,. Stones .�.. Waste Disposal <br /> Moving ...... AreaSystem . .. .. . <br /> Wrecking ...... Septic Tank Size <br /> Mobile Home 5. Permits Required Absorption Field Siete ons <br /> q <br /> D m <br /> Privy •••••• Subdivision <br /> Well ••• •• • Sanitary <br /> Subdivision ... ... Building Soil Type..... .. .. . ... . <br /> Well . .. ... o <br /> Slope a <br /> Other (Specify) DryPerRate . .. .. .. . <br /> ••• ••• Dry .. .. 1 <br /> 2. Classification /� Well <br /> Zoning Dist. . .2� ditional <br /> 4Ql- Seepage Trench <br /> PrivyLan . .. ... <br /> 3. Lot Size hh ,,'' 6. (describe exactly, l`_% Seepage Bed <br /> A�/ vel.Q, ft. fam.Thome, motel, etc.) FOR COMMERCIAL USE <br /> •/•U. ft. x Plans Submitted . .. .. . <br /> . . ........ ... ... . sq. ft. Plans Approved . .. ... V <br /> &S'ement DYa� n <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 A <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 /> r <br /> rM1 <br />