Laserfiche WebLink
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 />Owner or Agent (please print) Contractor or Surveyor <br />rcf. c.{....5 /............................................. <br />Address Address <br />Pho�It Phone°............. ................................ <br />Plumber Well Driller <br />.....���� .- ................ ............................... <br />Address Address <br />Phone................................... Phone ................................... <br />DESCRIPTION <br />4. Building Details <br />1. Work (check one) t / <br />Type—of Construction <br />/ �?. r•C+ <br />New Building <br />.. ", . <br />• • • • •I • <br />Addition <br />: ; • •y <br />Size A k. ft. x <br />Sanitary <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 />t.�' <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 be exactly, 1- <br />. � C 9 . ft. x :3:: ..7 ft. <br />am. home,,anotel, etc.) <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 />4 . . �? .... Gallons <br />Absorption Field Site <br />Soil Type . -:V.(74. W . <br />Slope ... <br />Perc. Rate `�.. <br />Dry Well ...... <br />Seepage Trench ...... <br />Privy <br />Seepage Bed /axcia <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 />i <br />4 <br />X <br />