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C <br /> Burnett County Office of Zoning Administrator !o � <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, :=j <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- <br /> lations of the State of Wisconsin. <br /> p <br /> . \ :f _ <br /> Owner orbAgent (please print) Contractor or Surveyor <br /> 7.. I.Q. .. "I.J.1 .. . .. .. .. .. . ... . . .. ... .. .. ................... ... <br /> Address Address ;tT <br /> Phone Phone <br /> p.......?.. .... . .. . ... . . . .. .. ...... . .. . . . .. .. .. .. .. . ... . . .. .. . . . . . d <br /> Plumber Well Driller eQ <br /> Address Address <br /> �y� 1 <br /> Phone .. . . .... .... . . .. .. .... . .. .. .. .. .... Phone <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities r <br /> 1. Work (check one) Type of Construction No. Bathrooms S ~ <br /> ( <br /> New Building R�� ` .. . . .... Dishwasher �* r <br /> Addition Garbage Grinder . .... . <br /> Sanitary Size .a1.4. ft. x l4 ft. Autom. Laundry <br /> Alterations ...... Height . .. . Stories . ... No. Bedrooms <br /> Waste Disposal <br /> Moving Area System .. . . . . :r <br /> Wrecking ...... Septic Tank Size C <br /> Mobile Home ... .. . 5. Permits Required <br /> Privy Subdivision 7,17d. .. . Gallons �' <br /> Well Sanitary Absorption Field Site <br /> I'3' Soil Type Q <br /> Subdivision . .. ... Building G. / Slope .. . .d <br /> Well G.�r' Pere. Rate . .. . . .. . es \ <br /> 2. Classification / //:l.�� cify)Other (Spe ...... : <br /> Zoning Dist. pCConditional Sp age Trench <br /> Land . .. .. . Privy <br /> 3. Lot Size 6. e e exactly, 1- Seepage Bed dX .0 :� o <br /> fam. home, otel, etc.) FOR COMMERCIAL USE <br /> x ' ' ''''' Plans Submitted <br /> pp 0 <br /> A. Q:� aq. ft. Plans Approved . .. .. . '�' � <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 as <br /> building until a permit has been issued. A permit may be revoked if misrepresentation of '0 <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 I <br /> SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />