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Burnett County Office of Zoning Administrator io <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <br /> To the Zoning Administrator: The undersigned hereby makes application for ;V <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. <br /> Owner or Agent (please print) Contractor or Surveyor ;� '-e 5 <br /> 6 J, e. n <br /> Address.. ...'.'. Address <br /> Pho . ..... . .. .. .. . . . . . ... .. . . . . . . .. . . .. .. Phone . .. ...... .... ... . .... .... .. .. . . . . . . . /�:� <br /> ...... . . .. . . .. . . ... . . .... .. .. ... . .. .. . . .. .. ... . . . . . . . .. . . . <br /> Plumber Well Driller At <br /> o :e <br /> Address.. . .. .. .. .. . . . . .. .. . . ... .. .. .. .. .. Address <br /> S :3 <br /> o <br /> Phone .. . . . .. ... .. .... .. .... ... . . .. .. .... ... . . . . . .. .. . . . . . . .. . . ... .. .... .. . . . <br /> Phone <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities : <br /> 1. Work (check one) Type-of Construction No. Bathrooms . .. . . . <br /> New Building <br /> I— Y• � t,� Dishwasher . .. .. . <br /> .. S <br /> �� • •••(• <br /> Garbage Grinder . .. ... <br /> Addition A <br /> Size A.� ft, x . .J�. ft. Autom. Laundry <br /> Sanitary <br /> , . <br /> Alterations . ... Stories . ... No. Bedrooms C <br /> Height Waste Disposal T <br /> Moving ...... AreaSystem . . . . . . <br /> Wrecking Septic Tank Size <br /> Mobile Home . .... . 5. Permits Required <br /> Privy . .7. X'. �'. . Gallons 0' <br /> �Y ✓• Subdivision . ..... c <br /> a <br /> L� Absorption Field Site / <br /> Subdivision . . . .. • <br /> Sanitary <br /> .'`i Soil Type <br /> Slope . ../.'�. .�/�b... o <br /> Well . .. .. . �"Z <br /> Other (Specify) . •, , , . Pert. Rate �. . <br /> 2. Classification y) Dry Well <br /> Zoning Dist. . .. ... Conditional : : . •f Seepage Trench . .... . :V� <br /> Land Privy <br /> 3. Lot Size 6. U be exactly, 1• Seepage Bed <br /> `� am. home, ihotel, etc.) FOR COMMERCIAL USE '> <br /> ft. x .... . ft. <br /> Plans Submitted . .. ... <br /> . . . .. . . . . . ... ... <br /> sq. ft. Plans Approved . .. ... V <br /> NOTE: A preliminary site inspection must be made and site approval granted on all strut- :4 <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 JQ� <br /> building until a permit has been issued. A permit may be revoked if misrepresentation of m <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 />