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o y 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 <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, E <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 <br /> Address Address o ;� <br /> Pho ......... .. .. .. .: .... .. .. .. .... .. .... Phone . . . .. .. • . .. .. .. . . ... . . . . . .. . . . . . .. . . <br /> Plumber Well DrIller < <br /> :s <br /> Address ....... Address. . . .. .. .. . .. .•. .... ..... .. . . .. ... . . :t4 <br /> .. ... . .... . . .. . .. .. . ' J <br /> •9 <br /> Phone .. . . .... .... .. .... .. ..... ..... ... .. Phone � :� <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities <br /> 1. Work (check one) Type�f Construction No. Bathrooms . .. . . . :m <br /> Dishwasher . . ... . <br /> New Building ... •.• • ..Q• .••••••• Garbage Grinder . . . .. . • <br /> Addition Size a_!. ft. x 3 c�—ft. Autom. Laundry <br /> Sanitary >� No. Bedrooms <br /> Alterations ..•... Height ... . Stories .... Waste Disposal C* :rn <br /> Moving ...... Area . .. ... . . . . . .. .. . <br /> Wrecking ...... """ " """"" Septic Tank Size , <br /> Mobile Home . .. .. . 5. Permits Required �CK d 0 GallonsPrivy �' + <br /> Well . l%. Subdivision •-- Absorption Site <br /> cr <br /> Subdivision . . . . . . Building �� Soil Type .A .S�.. . . <br /> Slope . . 4 n <br /> Per <br /> 2. Classification `\ Other (Specify) ,..Well Dry Rate <br /> Dry Well <br /> Zoning Dist. Conditional ••••• • Seepage Trench . . . ,.. <br /> Land ... . . . Privy :f, <br /> 3. Lot Size 6. U be exactly, 1- Seepage Bed X a 1 a <br /> fa . home otel, etc.) FOR COMMERCIAL USE :� <br /> ft. x .. .. .. . ft. <br /> .� Plans Submitted ' <br /> a•,��,• . ..C .J, sq, ft. Plans Approved . .. ... 'o <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 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 d <br /> building until a permit has been issued. A permit may be revoked if misrepresentation of <br /> A <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 />