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m o Z <br /> Burnett County Office of Zoning Administrator g <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <br /> To the Zoning Administrator: The undersigned hereby makes application for O 53 <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, :� p <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 (please print) Contractor or Surveyor <br /> t.Address Address :O <br /> Phone_ 'l Phone ;� <br /> rt .... .... . . ..... ... .. . ... . . . . . . .. . . . d d� '� <br /> Plumber Well Driller .� <br /> A. .ddress.. .. ...... .. .. . . .. ........ .. . .. . ....... . (� <br /> Address :. <br /> Phone Phone <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities J <br /> 1. Work (check one) Type of Construction No. Bathrooms <br /> Dishwasher <br /> New Building . •t• . <br /> Garbage Grinder ..... . :c� <br /> Addition • •.... A2 ft. <br /> ft. x 3 G. Autom. Laundry ...... :L $U <br /> . .. ... <br /> Sanitary See <br /> No. Bedrooms . ... .� � <br /> Alterations ...... Height . ... Stories . ... Waste Disposal d <br /> Moving ... ... System 9 <br /> Area ... ... . .. .. ... .... N <br /> :3 '� <br /> Wrecking ...... Septic Tank Size ' Ul <br /> Mobile Home ..... . 5. Permits Required <br /> Privy Subdivision •• ••• •� ..•• Gallons <br /> Absorption Field Site <br /> Well ...•• . Sanitary ✓ e <br /> Subdivision Building Slope hL�S•q`""` <br /> Well .. ... Perc. Rate <br /> 2. Classification Other (Specify) ,,, ,, • <br /> a•R U(��� <br /> 1 <br /> Dry Well . . ... . J( <br /> Zoning Dist. ...... Conditional Seepage Trench . .... . <br /> Land . .. . . . :ro <br /> Privy .. . .. U <br /> 3. Lot Size 6. Vo des r'be exactly, tL' Seepage Bed 1.4X.I? c d <br /> �U <br /> fam. home, otel, etc.) FOR COMMERCIAL USE ft. x ?2/0. ft. Plans Submitted 1 y <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 <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 :ai <br /> SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />