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0 0 <br /> Burnett County Office of Zoning Administrator ` <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT ;r <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 .N <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 andthe laws and regu- <br /> lations of the State of Wisconsin. <br /> . ............ ... ...... .... ............ .... . ... ........ . <br /> Owner or }lgent (please print) Contractor or Surveyor <br /> S <br /> . .......... ..... . . <br /> Address Address <br /> 5............ .. .... ................... .... .... ..:. <br /> .. . ........ <br /> Phone Phone F <br /> . .... ..... . ....... .......... .... .... ........ .... . ... . <br /> Plumber Well Driller • !� <br /> s . <br /> Address Address <br /> ..... ........ .. . <br /> s. . <br /> Phone Pti.on..e ' <br /> 2 <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities ' <br /> 1. Work (check one) Type of Construction No. Bathrooms <br /> .. <br /> i'ft Vt,i fr Dishwasher . ..... r .. <br /> New Building .X.. L1" " """ " Garbage Grinder . .... . ;:;ai <br /> Addition Size ft. x : n.. ft. Autom. Laundry PQ1 <br /> Sanitary ...... No. Bedrooms <br /> Alterations ...... Height !).. Stories ..I.. ;� <br /> r Waste Disposal ; <br /> Moving ...... Area ....x?[�_ /7:� �fi SYstem <br /> Wrecking ...... -D Septic Tank Size . ..... :['� <br /> Mobile Home ...... 5. Permits Required p „0 m <br /> .I�... Gallons Q, <br /> Privy Subdivision .... . b s e l� �r Q <br /> Absorption Field Site y K' <br /> Well � .. Sanitary .X... Soil Type . Stt.ii41 ... �. a <br /> Subdivision ... ... o <br /> Buildin ..�'.. . f' <br /> Building Slope ...Q... ..... .... ° W <br /> Well . .�... Pen. Rate .R:� e4e.hVn• �- g <br /> 2. Classification /�Q Other (Specify) ...... Dry Well t ... ... n .a p <br /> Zoning Dist. r1 /' LandConditional ... ... Seepage Trench ... ... ;F , j UC' <br /> Privy '^ <br /> 3. Lot Size ti. Use (describe exactly, Seepage Bed <br /> I0.0... Pt. x A. <br /> tam. home, motel, etc.) FOR COMMERCIAL USE a f <br /> .3.1?r�. n� p <br /> Plain Submitted ...... <br /> _30,4 P 0.. .... sq. ft. Plans Approved . ..... %"' V <br /> g, <br /> NOTE: A preliminary site inspection must be made and site approval granted on all struc. '} I <br /> tures involving sanitary facilities before construction can begin. In the case of sewerage dis. r. <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 4 w° <br /> building until a permit has been issued. A permit may be revoked if misrepresentation of "~ n <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 S ' <br /> SHALL NOT BE COVERED UNTIL INSPECTED BY THUS OFFICE AND APPROVED. <br /> t <br /> 1 <br />