1973/10/29 - LAND USE - SUB - Subdivision - 03281

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rJ y z Burnett County Office of Zoning Administrator g APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT a To the Zoning Administrator: The undersigned hereby makes application for o + a Permit for the work described and located as shown herein. The undersigned agrees that ;n. C all work shall be done in accordance with the requirements of the County Zoning Ordinance, .tea p Sanitation Code, and with all other applicable County Ordinances and the laws and regu- lations of the State of Wisconsin. .V.O.yAgP.r. .Vj.j1.ag.e. .. .1R(;.. .. . .. .. .. . . . . . . . . . . . . .. . Owner or Agent (please print) Contractor or Surveyor .0 Box 395, Danbury, Wis 54830 110 Main St. ., Reedsburg, Nis Address Address • 53959 : CD 7�5.-.259.-.33.24. . . . . . . . . . . . . . . . . . . .. . . 608- 524- 2386. .. . :c Phone ~ Phone . . . . . .. .. . . . .. . . � N/A N/A d �' ... . . .. . . . . .. . . . . . . . . . . .. .. . . . . . . . . .. .. .. . . .. . . .. .. . . . . . . . .". . . . . . . . . . . . Plumber Well Driller N/A . . .. .. . . . . . . . . . . . . . .. N� . . . . .. . . . . . . . . .. .. .. .. . . . .. . . . . .. .. .. . Address Address N/A. .. .. .. . . .. .. ... . .. .... ... . . .. . . .. .. N�A. . . . . . . .. .. . . . . .. .. .. . . . . . . . . .. . . . . . . Phone Phone 41 DESCRIPTION 4. Building Details 7. Sanitary Facilities 1. Work (check one) Type of Construction No. Bathrooms . . . . . . �+ Dishwasher . . . .. . New Building Addition . .. •,, Garbage Grinder :o Sanitary Size . . . . . ft. x .. . . . ft. Autom. Laundry . .. . . . �. No. Bedrooms . . . Alterations .. . ... Height . . . . Stories . .. . Waste Disposal Moving . .. .. . Area System . .. . . . :w Wrecking ...... Septic Tank Size Mobile Home . .. .. . 5. Permits Required Gallons Privy Subdivision Absorption Field Site SanitarySoil Subdivision . . . . . . Building Slope e. .. .. .. .. . . . . . 0 Building . . . .. . Well Pere. Rate . . . . . .. . . . . . 2. Classification ��I� Other (Specify) . ... . . Conditional Dry Well Zoning Dist. . .... . Seepage Trench . . . . . . Land .`�. . Privy . . . . . . P 3. Lot Size 6. Use (describe exactly, 1- Seepage Bed . . . . . . c f� fam. home, motel, etc.) FOR COMMERCIAL USE r* � x . . .... . ft. qPlans Submitted . . . . . . .. . . . .. . . . . sq. ft. Plans Approved . .. .. . V z NOTE: A preliminary site inspection must be made and site approval granted on all struc- - tures involving sanitary facilities before construction can begin. In the case of sewerage dis- posal systems, a copy of the percolation test must be attached to this application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start anyOQ building until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or specifica- tions shall not be made without approval of the Zoning Administrator. SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED.