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, yr <br /> d 0 z <br /> Burnett County Office of Zoning Administrator g <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT o °, <br /> To the Zoning Administrator: The undersigned hereby makes application for :(Q :bQ <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, :¢) :O O <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- <br /> lations of the State of Wisconsin. �` ( .f9, <br /> 'i.� .. .... .... .�.4.eh.h.... ,J.`f . .1. .P... .. .. .. . . . ... . <br /> Owner or Agent (please print) Contractor or Surveyor <br /> . . . . . . .. . .. .. .. .. .... .. . ...... ....... :N <br /> Address Address <br /> Phone Phone '\ <br /> Plumber Drille .. ... . .. . . . . . . . . . . . . . . . . . . . . . . . <br /> ll r <br /> y <br /> Address <br /> .. .. . . .. .. . . . . . . . . . . . . . . . .. .. . . . . . a <br /> Address. . . . . .. . ... .. .. .. .. . . ... .. .. ...... � •� <br /> Phone .. . . . . . . .... .. . ... .... ... . ......... Phone . . . . . . . . .. . . .. . . . . .. . . .. . .. . . . . .. . . . : Y <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities :C0 r <br /> 1. Work (check one) Type of Construction No. Bathrooms . . :tp[ <br /> _ <br /> � �/ Q �w. Dishwasher <br /> New Building . .... .... .. Garbage Grinder . .. . . . <br /> Addition Size . . .. . ft. x . . .. . ft. Autom. Laundry <br /> Sanitary <br /> Alterations ... ... Height No. Bedrooms <br /> . .. . Stories ::: : Waste Disposal <br /> Moving . ..... Area . . System . .. .. . Z <br /> Wrecking ...... Septic Tank Size ; <br /> Mobile Home ..... . 5. Permits Required / d•!r���• • . Gallons <br /> Privy / Subdivision . . . . > c <br /> (/ Absorption Field Site <br /> Well 'Sanit �r <br /> � Soil . . <br /> .'.... . . ... .. <br /> Subdivision . • . •• • Building .�•� L $ <br /> Slope <br /> Welles Perc. Rate . . . . . .. .. . . . p <br /> 2. Classification Other (Specify) . .. .. . Dry Well <br /> Zoning Dist. Conditional • • •• • • Seepage Trench . .. .. . <br /> Land . . . . . . Privy <br /> 3. Lot Size 6. Use (describe exactly, 1- Seepage Bed <br /> fam. home, motel, etc.) FOR COMMERCIAL USE <br /> ...... . ft. x . . .. .. . ft. Plans Submitted . . .. .. <br /> ft. d1 tx Plans Approved . .. . . . :a,,: ti r <br /> 1 <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 m ust be attached to this application before a ,. r <br /> permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any : (n <br /> building until a permit has been issued. A permit may be revoked if misrepresentation of Q; 4 <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 /> 11� � <br /> U: <br /> l <br />