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o c <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, t <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- <br /> latio of tY? State of Wisconsin. <br /> -. ...... .... .t. .. . . .. .. .. . . . . . . ... . .. . <br /> Owner or nt (please print) Contractor or Surveyor <br /> ... ...... �bUr <br /> Address Address ' <br /> Phone Phone ;� <br /> Plumber .... ..... .. .. .......... .. .. ..... . Well Driller.... . . ... . . ... .. .... .. .. . . . . . . . C � . <br /> Address. .. . . .. .... .. .. .. ....... .... .. .... Address... .. .. .. . . .. ...... .... . .. .. .. ..... � � :� <br /> Phone .. . . .... .......... ....... .... .. .... Phone .. .. .. .. .... .. .. .. .. . ...... .... .. ... <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities <br /> 1. Work (check one) Type of Con traction No. Bathrooms . .. .. . <br /> New Building ,,, �ad..,.,, Dishwasher <br /> Addition Garbage Grinder . .... . :ram <br /> Sanita . . Size ...e ft. xC.4 ft. Autom. Laundry . .... . <br /> �' No. Bedrooms <br /> Alterations ...... Height . .. . Stories . ... Waste Disposal <br /> Moving ...... Area System ... .. . <br /> .............. .... <br /> Wrecking ...... Septic Tank Size <br /> Privy <br /> Home ::;;:: 5. Permits Required .R.0.0 0. ... Gallons <br /> Well Subdivision • •••.• Absorption Field Site <br /> Sanitary <br /> Subdivision . . .. .. Building Soil Type . .. .. ... ..... <br /> Well . .. .., Slope <br /> _ Other (Specify) Pere. Rate . . .. .. <br /> 2. Classification • •• •• • Dry Well 5 , 4, N <br /> Zoning Dist. .. LCaondditional .. ... . Seepage Trench . . . ... ;(� <br /> Privy •�_ ' . <br /> 3. Lot Size 6. Use (describe exactly, 1- Seepage Bed . .. . .. c <br /> ft. x .... .., ft. fam. home, motel, etc.) FOR COMMERCIAL USE {� <br /> I Q C�� r Plans Submitted <br /> ..... .. . ..t q�#t � " � Plans Approved . .. ... 'd <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 : <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 />