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wCJ o c <br />Burnett County Office of Zoning Administrator <br />0 <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, <br />Sanitation Code, and with all other applicable County Ordinances and the laws and regu- <br />lations of the State of Wisconsin. _ I� <br />Owner or Agent (please print) Contractor or Surveyor. <br />.�?.X ...:�?.�.....fy:�. ........................................ '\l <br />Address Address <br />. �.........`...� ................................................ <br />Phone Phone <br />Plumber ................................. Well Driller................ ............... :l <br />Address Address s <br />Phone Phone � "1" <br />DESCRIPTION 4. Building Details ?. Sanitary Facilities <br />1. Work (check one) Type <br />of Construction No. Bathrooms a <br />New Building ;', . ... G:�f�.:9. Dishwasher ...... <br />_/ �'� ' Garbage Grinder ...... +C <br />Addition Size `f• ft. x ft. Autom. Laundry ...... <br />Sanitary ...... 1 No. Bedrooms <br />Alterations ...... Height .. • . Stories Waste Disposal <br />Moving Area ' S <br />stem ...... <br />Wrecking ...... <br />Septic Tank Size ; <br />Mobile Home ... 5. Permits Required A <br />Gallons <br />Privy Subdivision Absorption Field Site <br />Well . • .... Sanitary .. W, s <br />Subdivision ...... Building Slol Typepe .............. O• <br />Well ...... <br />Perc. Rate ............ <br />2. Classificationn Other (Specify) ...... Dry Well :\ <br />Zoning Dist. //1_ q� Conditional Seepage Trench . <br />Land ...... Privy,l% : <br />3. Lot Size 6. Use (describe exactly, 1- Seepage Bed ...... o <br />fam. home motel etc. <br />x � �� � ) FOR COMMERCIAL USE <br />r Plans Submitted ...... <br />7r.U. ..... sed-• G '9� 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 cs <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. 7J> <br />