Laserfiche WebLink
Burnett County Office of Zoning Administrator U1 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <br /> To the Zoning Administrator: The undersigned hereby makes application for f y'; <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. y <br /> u .. . .. .... .. -: ...�. . .. . . . . . . . . .... . <br /> Owner orgent (please print) Contractor or Surveyor <br /> 19 AJ rV-A y rl r\... •tr S9 3 ...... .. ....... ...... ...... . r <br /> Address Address : <br /> .. .. .. .. .. ....... . .. .. . . . . .. . . . . ... . . <br /> Phon ...... .. .. ..... .. .. . . Phone <br /> ....... . .... .. .... ..... . . .. .. .. . . d :� <br /> Plumber Well Driller :> <br /> . . .. .. .. .. . . . . . . .. .. . . ..... . . . .. . .. . . .. .. . <br /> Address Address <br /> Phone .. .. .. .. .. .... . . . . .. .. .. .. . .. .. .... Phone <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities I <br /> 1. Work (check one) Type of Construction No. Bathrooms . .. <br /> (_ �_ r r`Q iyy� Q Dishwasher <br /> New Building ... ... <br /> ^ Garbage Grinder . ... A <br /> Addition Size .44�Q. ft. x .3�r ft. Autom. Laundry <br /> o� <br /> Sanitary . . ... No. Bedrooms <br /> Alterations ...... Height Stories . .. . Waste Disposal <br /> Moving ...... AreaSystem <br /> Wrecking . ..... """" "• • ' Septic Tank Size <br /> Mobile Home . .... . 5. Permits Required <br /> .7.T .. .Q m. . . . Gallons a <br /> Privy Subdivision Absorption Field Site <br /> Well Sanitary • •. .. . Soil Type . . ' <br /> Subdivision Building <br /> Slope ... . . .. .. .. .. .. . o <br /> Pere. Rate . . . . . . . .. . . . p ` <br /> 2. Classification Other (Specify) .... . . Dry Well . .. .. . <br /> Zoning Dist. . ..... Conditional Seepage Trench <br /> Land . . . . . . ivy <br /> 3. Lot Size6. exactly, 1- Seepage Bed /10.d c <br /> ft. x 7,O c� ft. fam. home,,motel, etc.) FOR COMMERCIAL USE : <br /> Plans Submitted ... .. . I <br /> . . . .. .. .. .. .. .. . . sq. ft. Plans Approved . .. .. . : .0 <br /> NOTE: A preliminary site inspection must be made and site approval granted on all strut- <br /> tures involving sanitary facilities before construction can begin. In the case of sewerage dis- 'K, t <br /> posal systems, a copy of the percolation test must be attached to this application before a Q <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 C <br /> SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br /> a <br />