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Burnett County 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, p <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- <br /> lations of the State of Wisconsin. y\ ;D <br /> Owner or Agent(please print) Contractor or Surveyor <br /> Address Address <br /> Phone Phone : <br /> Plumber Well Driller c� <br /> Address Address ' <br /> .. .... .. .. .. . . . .. . . . . . .... <br /> Phone Phone � <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities <br /> �e <br /> 1. Work (check one) Type of Con,truction No. Bathrooms . . . . . . <br /> r« <br /> New Building Dishwasher <br /> Garba G . . . .. . <br /> Addition z • V• ge Grinder <br /> Size . .. .. t. x .. ... ft. Autom. Laundry <br /> Sanitary No. Bedrooms <br /> Alterations ...... Height . .. . Stories . .. . Waste Disposal - <br /> Moving ...... Area System <br /> Wrecking . .. .. .... .. . .. . .. . <br /> Septic Tank Size <br /> Mobile Home ..... . 5. Permits Required ';2 c' <br /> /.-. Gallons <br /> Privy • •• •.• Subdivision Absorption Field Site a' i6' +j <br /> Well • • Sanitary . . <br /> Soil Type . .. .. ... .. . . . <br /> Subdivision Building . .. .. . Slope . .. .. .. . . .. . . . <br /> o <br /> Well •. • •• • Pere. Rate <br /> 2. Classification Other (Specify) . .. . . . Dry Well .. . .. . <br /> Zoning Dist. Conditional •• • •• • Seepage Trench -- <br /> Land . .. .. . Privy : C) <br /> 3. Lot Size f&. Use (describe exactly, 1 Seepage Bed /`�a <br /> ft. x ft. <br /> fam. home, motel, etc.) FOR COMMERCIAL USE C <br /> . . .. . . Plans Submitted . .. .. . <br /> . . . .. .. .. .. .. .. .. sq. ft. Plans Approved . .. .. . 'v <br /> NOTE: A preliminary site inspection must be made and site approval granted on all strut- <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 : o <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 />