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s5 C <br /> G O <br /> Burnett County Office of Zoning Administrator ao `— <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 .a <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. :61 <br /> 'a <br /> Owner or Agent (please print) Contractor or Surveyor •j <br /> o.y.... .... ...... .. . <br /> Address Address <br /> Pho ..,. ..... ... . .. . :.... ... . .. .... . . . . . . Phone . ... ... .. .... .. .. . . .. ... . .. . . .. . . . . . <br /> Al <br /> .... . .. . . .. ... . . . . .... .. . ... . ... .. . . .. .. . . d b� <br /> Plu ber Well Driller {� <br /> . . . . . . .. .. A. . ..ddre...ss..... .. .. <br /> Address s <br /> Phone .. . . .. .. ...... . ..... .. .. .. .... Phone <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities <br /> 1. Work (check one) Type of Construction No. Bathrooms ,.. . r <br /> New Building ... . l.1CC Srn,g,,, ,, Dishwasher » <br /> CJ Garbage Grinder . : <br /> Sanatary . .{ Size AY. ft. x ,a.�l ft. Autom. Laundry r� <br /> Alterations .. .... Height . . . . Stories .... No. Bedrooms 7.. . 2 <br /> Movin Waste Disposal <br /> g ... ... System <br /> \ •� <br /> T, <br /> Wrecking S stem . .. . . . <br /> Area . .. .... . ... .. . ... . Septic Tank Size <br /> Mobile Home . .... . 5. Permits Required I d u �' m <br /> ' <br /> Privy Subdivision ••• ••• Gallons :� <br /> Well Absorption Field Sit# ' <br /> Sanitary <br /> Building <br /> Slope .z.l.."^. . .<Y. . ...... .Subdivision Soil Type <br /> Well . .. ... Perc. Rate . . . . . .. .. . . . <br /> Other (Specify) • •. .2. Classification <br /> v <br /> Zoning Dist. . ..... Conditional . . ... . g page Trench . . . .. . f'( <br /> Land . .. . . . Privy \ <br /> r, <br /> 3. Lot Size tr. se (descri exactly, I. t—Seepage Bed <br /> � 0 OS O am. home, mo el, etc.) FOR COMMERCIAL USE :y <br /> ..... . ft, x ..d.... . ft. Plans Submitted �r <br /> . . . . . . . .. . . .. . . . . sq. ft. Plans Approved . . . .. . <br /> NOTE: A preliminary site inspection must be made and site approval granted on all struc- O <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 Xl <br /> permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any , 04 <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 />