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' Burnett County - - Office of Zoning Administrator G .� <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <br /> To tiro Zoning Administrator• The undersigned hereby makes application for <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,. 7-r p <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and re; • �j.£ <br /> lati ns of the States of Wisconsin. <br /> o <br /> . .... . .. :.... ... v f o I <br /> Owner or Agent (please print) - Contractor or Surveyor I <br /> . .............................. ........ ... <br /> Address7 Address <br /> S a.ai <br /> .. .: Q�. ... . .r . .. ...1....... .... .... .. . ... .... .. .... . . ... . . <br /> Phone J � Phone <br /> F� ..5... .. ........ ...... .......... .... .... .... .. . 5' <br /> Plug Well Driller <br /> nAcress <br /> . .... . ... .... .... .... .. ......... .... Aaa... rea, ° T <br /> S <br /> ... ....... .... .... .. ....... ........... <br /> Phone Phone <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities � <br /> 1. Work (check one) Type of Construction No. Bathrooms <br /> �,z r>r..e... Dishwasher ... ... .. <br /> New Building ..�� •••• •• • - _•• Garbage Grinder ...... ' <br /> Addition Size .°�.t.y ft. x 3., ft. Autom. Laundry `\ <br /> Sanitary . .(�! <br /> No. Bedrooms ..�J.—.. �y <br /> Alterations ...... Height ... . Stories . ... Waste Disposal : 1 <br /> Moving ... ... System . .. . <br /> Wrecking ...... Area ... .... ........ ... Septic Tank Size . <br /> Mobile Home ..... . 5. Permits Required <br /> Privy Subdivision rp� • el� Gallons <br /> Well ...... Sanitaryc� Absorption Field Site <br /> L Sail Type -S <br /> Subdivision ... ... BuildingL/. Slopey .. o <br /> Well T� (Specify) 'f_ Pere. Rate F.. . . . <br /> Other z. . g <br /> 2. Classification -Yj�P y) -•• •• Dry Well . .... . ' <br /> Zoning Dist. P Conditional .. ... . Seepage Trencha; <br /> .. . .. <br /> Lana ... ... Privy . <br /> 9. Lot Size6 <br /> . descnbe exactly, I. Seepage Bed ti?.o ll <br /> - fam. home„motel, etc.) FOR COMMERCIAL USE <br /> ....... ft. z . ...... ft. Plans Submitted . ..... ;Jd <br /> 6.n of sq. ft. Plans Approved ...... ;C V - <br /> J F ,� <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 to ust be attached to this application before a :p <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 10 <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 /> I <br /> i <br />