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doo <br /> Burnett County Office of Zoning Administrator :f <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT ` Vl <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, v :a p <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- 0 <br /> latio s of the State of Wisconsin. y <br /> . ... .... .. . .. . . .,.Q. . ... . . .. .. . . . 71. . . . . .. .. . <br /> Owner or Agent (please print) Contrac. .tor or Surveyor ;p <br /> NC. ./U� .. .. .. .... . .. .... .. .... . <br /> Address Address • <br /> . . . .. .. . . .. . . ... . .. . . . . . . .. . . . . . . P.hone.'o'n'e . .. .. . . ... . .. . . .. . . . . .. .. .. . . . .. . . <br /> ; <br /> Plumber Well Driller v <br /> ;G <br /> Address Address <br /> . . . .. .. .. . . .. . . .. .. . . .. . .. . ... .. . . . .. ... . . . . . . . . .. . . . . . . . . .. . . .. . . . . .. . .. . . . � <br /> Phone Phone � • <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities I <br /> 1. Work (check one) Type of Construction No. Bathrooms . . . .. . <br /> / r2..XC.S /.!1�. .. .. Dishwasher . . . . . <br /> New Building ✓. . Garbage Grinder <br /> Addition • • ••• • Size . . . . . ft. x . . .. . ft. Autom. Laundry <br /> Sanitary C i No. Bedrooms <br /> Alterations ... ... Height . . . . Stories .... System . . . <br /> Waste Disposal <br /> Moving . .... . <br /> Wrecking ...... Area . .. . . .. . . .. .. Septic Tank Size :h <br /> Mobile Home . ... . . 5. Permits Required 7�•O • , •• • Gallons �' o <br /> Privy Subdivision . . a <br /> Absorption Field Site/ <br /> Well !• . Sanitary . .. . . Soil Type c <br /> Subdivision . . . •• • Building � >� Slope . . °o <br /> Well Perc. Rate . . . . . . . . . . . . e <br /> 2. Classification Other (Specify) Dry Well <br /> Conditional T <br /> Zoning Dist. ... .. . � •• � • • Seepage Trench . . . . . . ; ^O <br /> Land . .. . . . Privy <br /> 3. Lot Size 6. exactly, 1- Seepage Bed <br /> faro. home, photel, etc.) FOR COMMERCIAL USE <br /> '' ' ft' x ''•• •' • R' Plans Submitted . r <br /> . .0 .4jy,c).�.'���q. ft. Plans Approved . .. .. . ro <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 :H <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 specifics- <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 />