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� O O <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 •� p� <br /> all work shall be done in accordance with the requirements of the County Zoning Ordinance, o <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- <br /> lations of the State of Wisconsin. , •, <br /> .. .. .. .. .. .. .. ... . .. .. .. .. . . . . . . . . .. .. . . . <br /> .Pwner or Agent (pleye pint) S.�G Contractor or Surveyor <br /> :. . . . . . ... . . .. .. .. .. .. .... ........ ... .... ... S� <br /> Address Address M <br /> Pho/ne ....... .. ...... . ... .... ...... .. .. .. Phone . ...... . . .... .. . . .. .. ... . .. . . . . . .. . . <br /> �.! ?e ...... .... .. .. . . . .... .. .... .. . . .. . ... . . .. .. . . . . . d <br /> Plumber ,,�� Well Driller <br /> . . . .�.!�.�. .... . '.. ..... .. s... .... .. ...... .. .. .. . . .. ......... . . .. . . .. .. .. . ° <br /> Address Address � <br /> Phone Phone <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities <br /> 1. Work (check one) Type of Construction No. Bathrooms . ..I. .. :) , <br /> New Building ... .• . ......... ......... ..... Dishwasher .. ... . 2 <br /> Addition Garbage Grinder � + <br /> Sanitary Size . .. .. ft. x . ... . ft. Autom. Laundry o <br /> No. Bedrooms ..:2— <br /> Alterations ...... Height . .. . Stories .... Waste Disposal <br /> Moving ...... Area ... .... .. ...... .. . System . .. . . . <br /> Wrecking ...... Septic Tank Size <br /> Mobile Home . .... . 5. Permits Required <br /> 1.s�.�... Gallons <br /> Privy Subdivision Absorption Field Site :y ' <br /> Well . .. . .. Sanitary <br /> Subdivision . .. .. . Building Soil Type .. .1I, <br /> Slope . .. .. .. . .�. <br /> Well . .. ... Pere. Rate . . . . . .. . <br /> 2. Classification Other (Specify) . .. .. . Dry Well . . . .. . \" <br /> Zoning Dist. . ..... Conditional •• ••• • Seepage Trench . .. ... <br /> Land . .. . . . Privy <br /> 3. Lot Size 6. Use (describe exactly, 1- Seepage Bed <br /> fam. home, motel, etc.) FOR COMMERCIAL USE <br /> ft. x . . .. ... ft. Plans Submitted . ..... Q <br /> . .. .. . ... . . ... .. . sq. ft. Plans Approved . .. .. . .0 <br /> W <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 />