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r <br /> o c <br /> Burnett County Office of Zoning Administrator 9 <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 :�3 <br /> all work shall be done in accordance with the requirements of the County Zoning Ordinance, :�, .�1� <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- ' <br /> lations of the State of Wisconsin. <br /> .... ...... . . . . . . . . .. . . <br /> Owner or Agent (please print) Contractor or Surveyor <br /> . . .. . . .... .. .... .. ..... ................ ..... <br /> Address Address <br /> ....��3:����. .. . . .. .. .. .. .. ........ .. .. .. .. . . .... ... . .. . . . . . .. . . <br /> Phone Phone : :tj- <br /> . ., - C�. ... . .... .. . . .. .... . . .. .. . . . . . d <br /> Plumber Well Driller < ;� <br /> Address Address <br /> Phone Phone ,� <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities <br /> 1. Work (check one) Type of Construction No. Bathrooms <br /> New Building is,, ....tvcD.GR•W ... . . . . .... DishwasherAddition '+ <br /> Garbage Grinder . 7.. . <br /> Sanitary . .. ... Size ft. x 9(K ft. Autom. Laundry . . ' <br /> Alterations ...... Height . 1. . Stories . ... <br /> No. Bedrooms . . ' <br /> Alter ,,, ,,, p f Waste Disposal <br /> Moving Area ... . 6�. System <br /> Wrecking Septic Tank Size <br /> Mobile Home . ..... 5. Permits Required <br /> Privy • • • •` . . .. . Gallons <br /> Subdivision Absorption Field Site <br /> Well Sanitary •� Soil Type <br /> Subdivision Building G ; <br /> Well <br /> ij: Slope .'!ra . . . ._ <br /> � Pere. Rate . . . . .rC.. � °p <br /> 2. Classification Other (Specify) Dry Well. <br /> Zoning Dist. h.:z` Land <br /> Conditional . .. .. . Seepage Trench 40. .. . O <br /> Privy Z1 <br /> 3. Lot Size 6. Use (describe exactly, 1- Seepage Bed jJ .1.7 y <br /> fam. home, motel, etc.) <br /> ft. x .... ... ft. FOR COMMERCIAL USE <br /> Plans Submitted <br /> 4/,Q..1... .. . sq. ft. Plans Approved . .... . :413 : 'd <br /> :(A <br /> NOTE: A preliminary site inspection must be made and site approval granted on all struc- r" <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 b <br /> permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any :r- <br /> building until a permit has been issued. A permit may be revoked if misrepresentation of el A <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 />