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C H Z <br /> Burnett County Office of Zoning Administrator _P <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <br /> To the Zoning Administrator: The undersigned hereby makes application for f <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. <br /> Owner or Agent (please print) Contractor or Surveyor Aj ' <br /> Address .. .. .. .... ... .. .... .. ........................ <br /> Address <br /> Phone Phone <br /> / •r f:.�•�:' .�.�� .5........ .. .. ..... . .. . . .. .. . . . . . C ;� <br /> Plumber Well Driller ,_ <br /> Address Address S <br /> Phone .. ............ .... .... ... .... ...... Phone .. . . .. .. .. .. .. .. .. .. ........ ... .. ... <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities <br /> 1. Work (check one) Type of Construction No. Bathrooms . . . . . ' <br /> New Building .:E- "� ... r.o `e&"�-.. ....., Dishwasher . . . .. . <br /> Addition Garbage Grinder . .... . + <br /> Sanitary . . Size .off. '. ft. x d`. ft. Autom. Laundry <br /> Alterations ..,... No. Bedrooms .� <br /> I'Y ;.a <br /> Height . . Storie Waste Disposal <br /> Moving ...... �/ sal •C <br /> Area 6.��.� System . . . .. . :�, <br /> Wrecking ...... •' Septic Tank Size �^ <br /> Mobile Home ... . 5. Permits Required q `7. .. Gallons <br /> Privy Subdivision Absorption Field Sit9 <br /> Well Sanitary :: Soil Type . : }`( �! Q <br /> Subdivision •• • •• • Building Slope ... .. . . ... • d <br /> Well . Ll , p <br /> Pere. Rate <br /> 2. Classification Other (Specify) ..... . Dry Well �' .Q} <br /> Zoning Dist. . ..... Conditional ..... . Seepage Trench . . . ... <br /> Land <br /> ;� <br /> Privy <br /> 3. Lot Size 6. Us be exactly, 1 Seepage Bed <br /> .j.!��. ft. x .`.' ft. a hom motel, etc.) FOR COMMERCIAL USE ` <br /> Plans Submitted . .... . <br /> . . ... . .. ... .. ... . sq. ft. Plans Approved . .. .. . V <br /> 3 <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 m ust be attached to this application before a ti <br /> permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any o <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 :(� <br /> SHALL NOT BE COVERED UN ASP CTED BY THIS OFFICE AND APPROVED. ,l <br /> n 11036 <br /> f .502dr I <br />