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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-' l � <br /> latio of the State of Wisconsin. t v n W <br /> �.b... .... ......... .... .... ........ .... ... <br /> Owner or Age, (please print} Contractor or Surveyor ,t <br /> ... .... .... .... .... ... .:. ...._... ...........I..... ........ ... <br /> . ... .......... <br /> Address Address <br /> ... ............ .... ...... .....I ...... .... ................... .... .... .... .. .. .... :'. . <br /> Phone Phone <br /> .S1 . ........... ........ ... ........ .. .... ..... ... ....... . .... ... . . € <br /> Plumber Well Driller - r <br /> C / <br /> . ....... .... ........ .... ............. .... . ss. .. ...... .... .. ......... . ... .... ... S. M <br /> Address Address <br /> . ... .... ............ .... ....... . ......... . ....... .... .... .... .... .... .... . ... ...... <br /> Phone Phone <br /> DESCRIPTION 9. Building Details 7. Sanitary Facilities ' <br /> 1. Work (check on Type of Construction No. Bathrooms . ... . . ;^ <br /> v�yr^r ? Dishwasher . <br /> New Building _ '�` - Garbage Grinder 0-. <br /> Addition Size . .... ft. x .. ... M. Autom. Laundry <br /> Sanitary L./ No. Bedrooms 4 tt :f1 <br /> Alterations ... ... Height ... . Stories . ... Waste Disposal <br /> Moving . ..... System .. . .. . t I I <br /> Wrecking ...... Area ......... ..... ... . Septic Tank Size .� . <br /> W <br /> Mobile Home ...... 5. Permits Required <br /> ' �__ Gallons <br /> Privell <br /> Absorption Field Site <br /> Sanitary <br /> S .......... ...Subdivision Building ...... Slope . . . .. .... . ... .. . �v� <br /> � <br /> o' <br /> Pere. Rale ... .... .... . <br /> Other (Specify) ����� � :v1 n <br /> 2. Classification Dry Well -'. ...... <br /> Zoning Dist. ...... Conditional . .... . Seepage Trench ;C <br /> LandPrivy <br /> 3. Lot Size 6. escribe exactly, L Seepage Bed <br /> fam. home, <br /> motel, etc.) FOR COMMERCIAL USE <br /> .... ... ft. x . .... .. ft. Plans Submitted . .... . � e <br /> ..5. . .. sq. ft. Plans Approved . .... . <br /> C : v <br /> X'j. <br /> NOTE: A preliminary site inspection must be made and site approval granted on all strut- <br /> lures involving sanitary facilities before construction can begin. In the case of sewerage dis- <br /> posalsystems, 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 m <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 /> . 1 <br />