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d o o <br /> Burnett County Office of Zoning Administrator S' g <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT . �N <br /> To the Zoning Administrator: The undersigned hereby makes application for i <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- ) 4 <br /> lations of t State of Wisconsin. `D <br /> V21./A <br /> wnerno gent lease print) Contrac or or Surveyor <br /> --(-7*--------- <br /> Address Address <br /> Phone Phone <br /> tii <br /> Plumber Well Driller <br /> Addree� Address <br /> a <br /> Phone Phone <br /> • <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities <br /> Type of Construction No. Bathrooms / <br /> 1. Work (check one) . <br /> New Building L'' Dishwasher <br /> Garbage Grinder <br /> Addition Autom. Laundry <br /> Sanitary ,� Size 3-. ft. x C. ft. No. Bedrooms L �a �—. <br /> Alterations Height . .. . Stories . ... <-� <br /> Moving • <br /> Waste Disposal fi' <br /> Area System , e <br /> Wrecking Septic Tank Size <br /> Mobile Home 5. Permits Required <br /> / :U , Gallons cR <br /> Privy <br /> Well . ./ Subdivision ••"• Absorption Fief Site j <br /> Sanitary •f: Soil Type ti� r'�(• • , <br /> Subdivision V o <br /> Building Slope I c <br /> Other (S ecif Perc. Rate ./.. — <br /> 2. Classification p Y) Dry Well • <br /> Zoning Dist. Conditional Seepage Trench <br /> Land Privy : <br /> 3. Lot Size 6. Use (describe exactly, 1- Seepage Bed /0/ 0 i o <br /> 6 fam. home, motel, etc.) FOR COMMERCIAL USE \: g <br /> .. ft. x ,� ft. <br /> Plans Submitted cg• <br /> sq. ft. Plans Approved 'o <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 gj <br /> permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any OR <br /> building until a permit has been issued. A permit may be revoked if misrepresentation of fD <br /> any of the information conveyed herewith is found to exist. Changes in plans or specifica • <br /> - <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 />