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Burnett County <br />Office of Zoning Administrator <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. ) <br />/7 I <br />Owner or Agent (please print) Contractor or Surveyor <br />37 <br />Address Address <br />......................................... <br />Phone � � q <br />.......... <br />Plumber <br />Address <br />.......................................... <br />Phone <br />Well Driller ............................... <br />Address................................... <br />Phone, 5.. _. �(-V(. 7 ................ 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 />Well <br />• • • . • • <br />Subdivision / <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 />....... <br />................. <br />sq. ft. <br />7. Sanitary Facilities I <br />No. Bathrooms <br />Dishwasher <br />Garbage Grinder ..•cam <br />Autom. Laundry <br />No. Bedrooms ...... <br />Waste Disposal <br />System. . <br />Septic Tank Size <br />... Gallons <br />Absorption Field Site <br />Soil <br />Slope .e..$.. f.... <br />Pere. Rate ... ....... <br />Dry Well ...... <br />Seepage Trench ...... <br />Privy <br />Seepage Bed iO K .fix <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 />