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on co <br /> d 0 z <br /> Burnett County Office of Zoning Administrator g {� <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <br /> To the Zoning Administrator: The undersigned hereby makes application for :r _ <br /> a Permit for the work described and located as shown herein. The undersigned agrees that VJ <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 /> .. . . . . . . .. .. . . � f ,q eaSo.n.S..... . .. . . . .. . . <br /> Owner or Agent (please print) Contractor or Surveyor <br /> ..&/P. 7.......... . <br /> Address Address (D <br /> Phone . .. .. .. .. . . .. . . . .. . .. .. .. .. .. .. . . . . Phone . . . . . .......................... .... . �� <br /> . - . � -jC. tv <br /> Plumber Well Driller � •; .--h <br /> o S ; <br /> . . . . . . . . . . . . . . . . . . . . . . . .. ...... .. . <br /> Address Address 8 ;� <br /> . . . . . . . . . . . . . . .. . . . . . . . . . ... .. . I. .. . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . <br /> Phone Phone <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities / <br /> 1. Work (check one) Type of Construction No. Bathrooms :(r <br /> I.y �y �_ Dishwasher . .. ... S <br /> I <br /> New Building . . . •••.... Garbage Grinder . ..... <br /> Addition Size ... ft. x 3 7. ft. Autom. Laundry ...... (f <br /> Sanitary . . . . . . No. Bedrooms <br /> Alterations .. . .. . Height . .. . Stories . .. . Waste Disposal <br /> Moving .. . . . . Area System <br /> Wrecking . .. ... Septic Tank Size <br /> Mobile Home . .. .. . 5. Permits Required / G' Gallons <br /> Well Subdivision �. Absorption Field Site, <br /> Well Sanitary ��,. . �. <br /> Subdivision Building Slope e ,ice.d.... .. . <br /> Well Pere. Rate .Ch'!• c;i, <br /> 2. Classification Other (Specify) 1..... Dry Well ? \ V <br /> Zoning Dist. • .. .. . Conditional ••...• Seepage Trench . . . .. . <br /> Land ...... Privy <br /> 3. Lot Size 6. Use (describe exactly, Seepage Bed <br /> ' x <br /> ft. Cfa>)home, motel, etc.) FOR COMMERCIAL USE E <br /> Plans Submitted <br /> �/ O.o. sq. ft. Plans Approved . . . .. . 'o <br /> `NA <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 <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 <br /> SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. �` <br />