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0 <br />Burnett County Office of Zoning Administrator <br />APPLICATION FOR SANITARY — <br />LAND USE — BUILDING PERMIT <br />To the Zoning Administrator: <br />The undersigned hereby makes application for <br />a Permit for the work described and located <br />as shown herein. The undersigned agrees that <br />all work shall be done in accordance with the <br />requirements of the County Zoning Ordinance, <br />Sanitation Code, and with all other applicable <br />County Ordinances and the , ws and re <br />lations of the State of Wisconsin. <br />s ]d <br />0 ._ .,. v -s #-rG�L7• .!... ............ <br />.......... ............................ . <br />Surveyor <br />Owner r Agent (please print) <br />Contractor or <br />61?'rc �� 1.-:�. <br />Height .... Stories .... <br />.�` . <br />Address <br />.......................................... <br />Address <br />Area <br />Wrecking <br />Fholne � <br />. .170.� ' ........... <br />Phone <br />............ . <br />Plumber <br />V. <br />Well Driller <br />5. Permits Required <br />Privy <br />Address <br />Address <br />Phone................................... Phone .................................... <br />DESCRIPTION <br />4. Building Details <br />1. Work (check one) <br />Type of Construction <br />New Building <br />...... <br />....................... <br />Addition <br />Size ..... ft. x ..... ft. <br />Sanitary <br />...... <br />Alterations <br />...... <br />Height .... Stories .... <br />Moving <br />•••••• <br />Area <br />Wrecking <br />...... <br />Mobile Home <br />...... <br />5. Permits Required <br />Privy <br />• • • • • • <br />Subdivision ...... <br />Well <br />• • • • • . <br />Sanitary <br />Subdivision <br />..... • <br />Building ...... <br />Well ...... <br />2. Classification <br />Other (Specify) <br />Zoning Dist. <br />...... <br />Conditional ...... <br />Land ...... <br />3. Lot Size <br />6. Use (describe exactly, 1- <br />fam. home, motel, etc.) <br />ft. <br />....... x ....... <br />ft. <br />................. <br />sq. ft. <br />7. Sanitary Facilities <br />No. Bathrooms ...... <br />Dishwasher ...... <br />Garbage Grinder ...... <br />Autom. Laundry .... <br />No. Bedrooms ... . <br />Waste Disposal <br />System ...... <br />Septic Tank Size <br />�� :� �.,...... Gallons <br />Absorption Field Site <br />Soil Type ............. <br />Slope .... .f ....... <br />Pere. Rate .Z......... <br />Dry Well ...... <br />Seepage Trench ...... <br />Privy ...... <br />Seepage Bed % c'/, a ... . <br />FOR COMMERCIAL USE <br />Plans Submitted ...... <br />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 <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 />ti <br />-a <br />0 <br />CX_ <br />