Laserfiche WebLink
d y 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 <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- <br /> lations of the State of Wisconsin. l <br /> . <br /> .77b01n.as . .R.�1�q. .. ... .... . .. Jnr.f � oa. �� s. > <br /> Owner or ent (please print) Con actor or Surveyor <br /> 7 71. ze/way .. ....4 .. . .S. .. ....... s <br /> , / <br /> Address tjf , fa(,c! �/N �s�Q�Address <br /> :J <br /> . ............ .. .. .. . . .... .. .. . . . . .... . . . . Phone....... .. .. .. . . .... .. .. . . . . .... . . . . ... .. .... .... .... .. .. .. .. .. .. . .. .. . . U1 <br /> ace <br /> t ......... .. .. ... . .. . . . ... . . .... . . .. . . .. . . . n <br /> Plumber Well Driller <br /> ! . e .. . .. .. . . . . •. . . .. .. .. . . . . . . . .. .. .... . <br /> adflress address S <br /> .. .... .. .. .. .. . . .. ...... . . . ........ Phone .. . . .. .. .. .. . . . . . ... . . .. . . . . ..... .. . <br /> Phone <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities <br /> 1. Work (check one) Type of Construction No. Bathrooms . . f S <br /> New Building 1 <br /> (716, Dishwasher <br /> ,,,• <br /> Garbage Grinder f�f� <br /> Addition Size �2 ft. x ft. Autom. Laundry <br /> Sanitary No. Bedrooms }� <br /> Alterations ...... Height Stories . ... Waste Disposal <br /> Moving ...... Area ... .... . . . System Wrecking ...... . . . . . . . . <br /> �) <br /> Septic Tank Size . <br /> Mobile Home . .... . 5. Permits Required ;�m <br /> Prig Y Subdivision . .. . 75<9•• Gallons <br /> Well ••L� Sanitary [� Absorption Field Site <br /> Subdivision Soil Type . .. ........ .. 5. c <br /> Building Slope <br /> «WellPerc. Rate . . .r.4 <br /> Other (Specify) . fj./. . . . <br /> 2. Classification P y) ••••• • Dry Well <br /> Zoning Dist. Conditional • •. • Seepage Trench : V`I <br /> Land . . .. . . Privy - <br /> 3. Lot S' 6. Use (describe exactly, Seepage Bed �7k i� : v c <br /> / 'zS ft fam. home, motel, etc.) FOR COMMERCIAL USE <br /> ft. x .. Plans Submitted ... ... <br /> sq. ft. Plans Approved . ... .. ; ; �V <br /> se- <br /> NOTE: <br /> eNOTE: 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 m 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 ofQ <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 :I/i CC <br /> SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />