Laserfiche WebLink
d y z <br /> 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, <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- <br /> lations of the State of Wisconsin. �� 'V <br /> Owner or Agent (please print) Contractor or Surveyor <br /> :� :Lj <br /> Addrer! ........ . Address... ...... .. ........................ •� <br /> Phone ........... .................. .. .... Phone . .. .. .. .. .... .. .. .... .... . .... .. . ... . <br /> tv <br /> t!'..s.Q.n: ........ .. .. ..... . .... . ... .. .... .. .. . . .. . . . <br /> Plumber Well Driller � <br /> Address Address s, '.LS <br /> Phone .. .. ........... ... .... ... .......... Phone i� .. <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities <br /> Type of Construction No. Bathrooms ...i. . . <br /> 1. Work (check one) , <br /> New Building .G ; ... .`. .: .:�...... Dishwasher . .... . -- <br /> Addition Garbage Grinder + <br /> Size ..�. ft. x iy S.�ft. Autom. Laundry <br /> Sanitary No. Bedrooms .. <br /> Alterations ...... Height . . Stories .... Waste Disposal � C <br /> Moving Area System . .. .. . <br /> ... .. ... . .. .. .... <br /> Wrecking ...... Septic Tank Size <br /> Mobile Home . ..... 5. Permits Required V <br /> Privy Subdivision • ••• Gallons :� (a <br /> Well Sanitary .,�� Absorption Field Site <br /> Soil Type <br /> Subdivision . . .... Building Slope . .�. p <br /> z� <br /> Well Perc. Rate <br /> 2. Classification Other (Specify) . ..... Dry Well : Q( <br /> Zoning Dist. Conditional •• •.• • Seepage Trench <br /> Land . .. . . . Privy <br /> i <br /> 3. Lot Size 6. Use (describe exactly, 1- Seepage Bed !'�.�`!Jr •n c <br /> fam. home, motel, etc.) FOR COMMERCIAL USE :91 <br /> ft. x ....... ft. <br /> Plans Submitted q <br /> sq. Plans Approved . .. .. . 'd <br /> NOTE: A preliminary site inspection must be made and site approval granted on all struc- : '9 'o <br /> tures involving sanitary facilities before construction can begin. In the case of sewerage dis- 'n ' <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 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 �A- <br /> SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. �) <br /> C <br />