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Burnett County -Office of Zoning Administrator S e p <br /> APPLICATION FOR SANITARY-- LAND USE — BUILDING PERMIT G G <br /> :r <br /> To the Zoning Administrator: The undersigned hereby makes application for <br /> a Permit for theworkdescribed and located as shown herein. The undersigned agrees that <br /> all work shallbedone 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. <br /> 0 <br /> as �� tem <br /> I/ x. X.rna... .... <br /> .... ........ . .. .... .... .... .... .. .. .... ....... <br /> Orwer or Agent (please print) Contractor or Surveyor <br /> f T' .... I`f .... .. .... .......... ... C : 1 <br /> Address Address <br /> L .. ................ .. .... ........ .. .. . . . <br /> {r Phon - Phone <br /> .15� ... ...... ... . .. . ........ ....... ... ...... .. .. . ... .. . d <br /> Plumber Well Driller <br /> Address Address � <br /> ...... ..:.......::.. ............. ........ ...... .. .... .... .... .... ......... .... ..... Y <br /> Phone Phone <br /> DESCRIPTION 9. Building Details 7. Sanitary Facilities <br /> 1. Work (check one) Type of Qonstruction No. Bathrooms ... ... <br /> New Building _... 'EXiSj^'q Dishwasher . .... . r <br /> Addition ✓ Garbage Grinder . <br /> Sanitary .. Size ..... ft. x ..... ft. Autom. Laundry <br /> Alterations ...... Height . ... Stories .... No. Bedrooms ., .. . \• :(A <br /> Waste Disposal „ _ , <br /> Moving ...... . <br /> Wreckin Area ... .......... . System . .... . <br /> g Septic Tank Size <br /> ...... W.� <br /> Mobile Home 5. Permits Required <br /> a . Gallons subdivision <br /> Well ...... sanitary Absorption Field Sit <br /> f:r <br /> ff� <br /> S?!* - Q <br /> Subdivision . .... . Building Soil Type �(/ e iv'= <br /> Slope ... ° e <br /> 2. Classification Other (Specify) ,, , Pere. Rate <br /> -_,,, Conditional Dry Well .. . ... :. G <br /> Zoning Dist. - . .... . Seepage Trench ... ... <br /> Land . .... . Privy .. .. <br /> 3. Lot Size 6. Use esc�be exactly, 1- Seepage Bed IaXa <br /> fam. hom1 76 c C\4" <br /> it o ft x �d... ft e: motel, etc.) FOR COMMERCIAL USE w — <br /> Plans Submitted . ..... <br /> . .... .... .... . ... sq. ft. Plans Approved . .... . <br /> NOTE: A preliminary site inspection must be made and site a <br /> p ry pe . In the granted on all e dis- <br /> posal <br /> A :� <br /> tures involving sanitary facilities before construction can begin. In the case of sewerage dis- ) <br /> poral systems, a copy of the percolation test must be attached to this application before a f <br /> permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any Z <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. A <br /> tions shall not be made without approval of the Zoning Administrator. SEWER SYSTEM :b <br /> SHALL NOT.BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. •� <br />