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o P <br /> Burnett County- - Office of Zoning Administrator 9 (� <br /> APPLICATION FOR SANITARY — LAND USE —.BUILDING PERMIT i ((/�� <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, <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 /> ....� Rd, S )mac! , ......?.$:... , . 4 .r..S. <br /> Address Address <br /> .... ........ .. . .... .. .. .... .... .... .... .. .. ... <br /> Phon Phone ... . .� <br /> . . . .. .. ... . C c <br /> ... ... .... .... ...... :. ... . .. .. ... ... . . .. . .. . . <br /> Plumber Well Driller m <br /> o <br /> C <br /> Address Address <br /> . ... .... .... ........ .... ........ ......... . ............ ....... .... .... ......... ..... .� <br /> Phone Phone <br /> x o <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities 'F <br /> 1. Work (check one) t� Type of Construction No. Bathrooms ..�� S <br /> y-v +-,.. Dishwasher . ... E <br /> New Building ..... . - -� ------ -- Garbage Grinder <br /> Addition Size y ft. x tt. Autom. Laundry . ..... \ <br /> Sanitary . ..... No. Bedrooms . .� . <br /> Alterations ...... Height . ... Stories .... - ;� <br /> Moving Waste Disposal <br /> Wrecking ..... Area ............. .. ... System 1' <br /> 6 Septic Tank Size <br /> Mobile Home ... .. . .5. Permits Required <br /> Privy Subdivision ... ." �"�" Gallons <br /> Well Sanit <br /> Absorption Field Site g ' <br /> >�- ary .�' Soil Type ..SSF,`.+. �. c <br /> 5 <br /> Subdivision ... ... Building . ..� @. e <br /> �� Slope .. . ..., o <br /> Well �� Perc. Rate <br /> Y1 ...... <br /> Other (Specify) . . �' i <br /> 2. Classification P Dry Well <br /> Conditional <br /> Zoning Dist. Seepage Trench . .... . <br /> Land privy, O <br /> 3. Lot Size s. Us describe exactly, I. Seepage Bed c <br /> m. home) motel, etc.) FOR COMMERCIAL. USE VI <br /> .(vo. ft. x 4_Sy it. <br /> Plans Submitted ... ... <br /> ... .... .... .... .. sq. ft. Plans Approved ... ... V U <br /> :(„-7 n <br /> _ S <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 i <br /> permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any 1� <br /> building until a permit has been issued. A permit may be revoked if misrepresentation of m 6 <br /> any of the information conveyed herewith is found to exist. Changes in plans or specifics- <br /> tionsshall not be made without approval of the Zoning Administrator. SEWER SYSTEM ;� ^ <br /> SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />