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C H 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 >3 <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- 11Ni :N <br /> Llatio s of the St Wisc�onnssm. <br /> s. .... .. .. . .. .. AmrdS . ... .. . i <br /> 0 er or Agent (please print) Contractor or Surveyor <br /> .. .. .. . . . . .. . . .. .. d.�C 6. �'!'.. . .��... ..... .. .... .. . . <br /> Address Address <br /> Phone _ / Phone <br /> �'� •�a?Z 1 e . . . .. . . .. . . . .. . .. . ... . . . . . . . . . . . <br /> Plumber Well Driller : <br /> Address Address <br /> �.-. . 3 . . .. .. .. ... .. .. .... .. . .. ... .. . <br /> Phone Phone ,� <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities <br /> 1. Work (check one) Type of Construction No. Bathrooms . .. . . . <br /> New Building ... . .. ..... .. .. ......... . .. .. Dishwasher <br /> Garbage Grinder . . . .. . <br /> Addition Size .. ... ft. x . . . . . ft. Autom. Laundry <br /> • '. .. . <br /> Sanitary . No. Bedrooms Q <br /> Alterations ...... Height ... . Stories . ... Waste Disposal �. <br /> Moving ... ... Area System . . . .. . :C <br /> Wrecking ..... . Segtic Tank Size <br /> Mobile Home . ..... 5. Permits Required � O0 <br /> Privy . . . .. .. .. . . .. . Gallons <br /> Subdivision Absorption Field Site <br /> Well • •• •• • Sanitary Soil Type . .. . . .... .. . . <br /> Subdivision . .... . Building . .. . . . Slope .. .. . . <br /> Well . .. ... <br /> Perc. Rate 7- 5'O ' ,•�a <br /> 2. Classification Other (Specify) . . . .. . Dry Well .. . ®v <br /> Zoning Dist. ICondditional ::::: : Seepage Trench . . . ... <br /> Privy <br /> Seepage Bed aX © <br /> 3. Lot Size 6. Use (describe exactly, 1- c <br /> fam. home, motel, etc.) FOR COMMERCIAL USE : a <br /> . ..... . ft. x . . .. ... ft. �. <br /> .} Plans Submitted <br /> . . ... . . . . .. .. .. . . sq. ft. ees /af�Yv�� Plans Approved <br /> :o <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 in ust 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 <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 />