Laserfiche WebLink
� 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, :yJ <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- <br /> lations of the State of Wisconsin. \ A <br /> or Surveyor <br /> Owner or ent (plea print) Contraofor <br /> IL:.. ca. sy�'�'� <br /> �dd)3ess Address <br /> Phone . .... .. ...... ... . .. .. .. ... . .. .. ... . Phone . .. .... .. .... .. . ..... . .. . .. .. .. ... . . <br /> �z�rlll . Lttj ��l .... . . ...... .. . . ... . .. .. .. . . .. . , <br /> Plumber Well Driller <br /> :�.. .... . .... ... .. . . .... ...... .. . .. . ... .. ... <br /> Address Address y <br /> Phone Plione <br /> 3 <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities <br /> 1. Work (check one) Type of Construction No. Bathrooms . .. . . . <br /> Dishwasher . .. .. . <br /> New Building ... . .. ......... ...... ... ... .. Garbage Grinder . .. .. . <br /> Addition .... Size . .... ft. x .. .. . ft. Autom. Laundry . ..... <br /> Sanitary . . No. Bedrooms . .. .. . <br /> Alterations ...... Height . .. . Stories .... Waste Disposal V. <br /> Moving System . .. .. . <br /> .... Area ....... .... .. .. .. . . I <br /> Wrecking Septic Tank Size <br /> Mobile Home . .... . 5. Permits Required Ql( / n Gallons 0' <br /> Privy • •••• • Subdivision Absorption Field Site <br /> cr <br /> Well •• • •• • Sanitary . .-?l. Soil Type . .. . ..... ... . � si <br /> Subdivision . .. ... Building ... .. . Slope d <br /> Well Pere. Rate . . . . . .. .. . .. <br /> 2. Classification Other (Specify) ... . Dry Well <br /> Zoning Dist. ... ... CondConditional .•. .• • Seepage Trench ' <br /> Privy <br /> 3. Lot Size 6. Use (describe exactly, 1- Seepage Bed . .. . . . o <br /> fam. home, motel, etc.) FOR COMMERCIAL USE <br /> ft. x .. .... . ft. Plans Submitted . . <br /> 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 <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 /> 02730 a 73J, S 90? 9 <br />