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m o 0 <br /> Burnett County Office of Zoning Administrator g <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <br /> To the Zoning Administrator: The undersigned hereby make�phcation 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 Ordinanc and the laws and regu- <br /> latio f.the $ta�tye 5of Wisconsin. <br /> .. . ... .. ... . ................... •� 4 <br /> Owner r nt (please print) Contractor or Su veyor <br /> - ...�:.. .... .. ... .... .. . ... . ..... .. .. ...................... <br /> A dr Address \ <br /> 1- 6 <br /> +7 .. .... ...... . .'� . . .... . .... . . <br /> hone Phone <br /> p� <br /> Plumb :?�.. ... .. .. .... . . Well Driller..� . .. .. . . . <br /> c <br /> ��.�. .. . <br /> Address. .. . . ...... .. .. .. ....... ...... .... Address <br /> ff <br /> Phone .. .. ........ .. .... ....... .. .. ...... Phone .. .�. . . .. . .(J .. .... .... ....... ... c :+5 m <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities <br /> 1. Work (check one) A-Xz <br /> Type of Construction No. Bathrooms .. . ... <br /> g .. .. t�.�� . DishwasherNew Buildin ��� y . Garbage Grinder <br /> Addition •••••• �`� 2 / ft. x .. ... ft. � Autom. Laundry ...... <br /> Sanitary . ..... �h ��/ No. Bedrooms ...... <br /> Alterations ...... eig t Stories .... <br /> Waste Disposal <br /> Moving ...... Area System ... .. . <br /> Wrecking ...... Septic Tank Size <br /> Mobile Home ...... 5. Permits Required <br /> Gallons <br /> Privy • •••• • Subdivision Absorption Field Site <br /> Well .... .. Sanitary . . • Soil Type . .. .. ....... . c <br /> Subdivision .. .... Building . . Slope <br /> Well . ...•' Pere. Rate . .. ....... .. p <br /> 2. Classification Other (Specify) ...... PDryer Well ... .. . <br /> Zoning Dist. .. Conditional ••.•• • Seepage Trench ...... <br /> Land Privy ..... . <br /> 3. Lot Size 6. Use (describe exactly, 1- Seepage Bed ... ... c <br /> fam. home, motel, etc.) FOR COMMERCIAL USE <br /> ...... . ft. x .. ..... ft. Plans Submitted ...... <br /> . .... .. ...... .... sq. ft. 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 : eo <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 TIES OFFICE AND APPROVED. ; <br />