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d a o <br /> Burnett County Office of Zoning Administrator g ;r <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT :-Z <br /> To the Zoning Administrator: The undersigned hereby makes application for ,M <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- p <br /> lations of the State of Wisconsin. <br /> :a <br /> Owner or Agent (please print) Contractor or Surveyor : 1 <br /> J-t\ <br /> Address Address <br /> Pho . .... .. .. .. .. .... .... .. .. . . .. .. . . .. . . Phone . .. .. .. . . . ..... . ..... .. .... .. . .... . . <br /> P .. .. . .s. . ... . . . . .. .. ... . . ... . . . ... . . . ... . .. .. .. . . ...... . . .. .. .. . . . r' <br /> Plumber � Well Driller � �,; <br /> o ' <br /> . .. . ... .. .. . .. .. .. . . .. .... . . . .. .. . ..dr.e.ss.. .. <br /> Address Ad <br /> . . . .. .... . . .. . .. . . . <br /> Phone ... .. . . . .... .. .. .. .... . . . . . . . . ... .. Phone <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities <br /> Type of Construction No. Bathrooms /. . . <br /> 1. Work (check one) • ' :�`I S <br /> r r q ,��, Dish*asher . .. .. . r. ' <br /> New Building ... . ... .. ... .... ... : <br /> Addition Garbage Grinder . .. .. . <br /> :: Size . ft. x .V.�� ft. Autom. Laundry :°q ;r <br /> Sanitary No. Bedrooms off-. : G Cj <br /> Alterations ...... Height . .. , Stories . ... Waste Disposal <br /> Moving . .... . System . . . <br /> Area <br /> Wrecking ...... •. '.• . . . . • • Septic Tank Size <br /> Mobile Home ...... 5. Permits Required r] 0 , Gallons0Privy Subdivision � F <br /> • • Absorption Field Site <br /> Well Sanitary Cl <br /> / <br /> . Soil TYP�S4 n.Q. .. s <br /> Subdivision Building Slope <br /> n Pere. Rate1 . . . . . . <br /> Other (Specify)2. Classification <br /> Dry Well . .. .. . :--j. i <br /> Zoning Dist. ��' 11111(jjj YYY Conditional • •• • • • Seepage Trench . .. .. . <br /> Land . . . . . . Privy qn o <br /> 3. Lot Size 6. U ribe exactly, i- Seepage Bed �irr•� H <br /> fam. home motel, etc.) FOR COMMERCIAL USE <br /> .... . ft. x . .. . ... ft. Plans Submitted . .. .. . <br /> a o o ®o5 <br /> . . . /.. .. . . .:f". . sq. ft. Plans Approved . . . .. . ;r� 'b O <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- 1 <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 anyts <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 />