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ex� � v t <br /> d y z <br /> Burnett County Office of Zoning Administrator <br /> 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT V\ <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, 'G p <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- : :a-. 0 <br /> lations of the State of Wisconsin. <br /> /e :ram... ... S .... . . .. . . .. . . . . .... .. . <br /> Owner or Agent (please print) Contractor or Surveyor <br /> Address Address ; ;5 jT <br /> Phone . .. .. ...... ..`. . .... .... . • . . .. .. .. . . Phone . .. .. .. .. .... .. .. .. . . .. . . .. .. . .. .. . . <br /> lf•`l.S . ....... . . . . . .. .. . . <br /> Plumber Well Driller...... .. .. .. .. . . . <br /> Address aaaress ,� ;,�, <br /> .. . . . . .. ... ... .. .... .. .. . . . . .. ... .. . <br /> Phone .. .. .. .. .. . . .. . . .. .. .. . .. . . ........ Phone <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities �e <br /> 1. Work (check one) Type of Construction No. Bathrooms :f <br /> New BuildingJ. .°^ ` ^' .. . ... .. Dishwasher . . . .. . 4 <br /> Garbage Grinder <br /> Addition , / Size �. '3 : •' <br /> Sanitary , •�• • �• ft. x . . ft. Autom. Laundry <br /> Alterations ...... Height . .. . Stories .,•_ No. Bedrooms . <br /> � <br /> Moving , • Waste Disposal <br /> ' ' Area System <br /> Wrecking . ..... Septic Tank Size ;j <br /> PrivyHome . .. .. . 5. Permits Required '7 S �. , ,, , Gallons ;s <br /> PY Subdivision <br /> Well Sanitary . .. Absorption Field Site <br /> y Soil pe S. <br /> Subdivision . . . .. . Building . Slope . . . . . . . . . . . .. . a <br /> Well v- <br /> Pere. Rate . . . . . . . . . . . . <br /> 2. Classification Other (Specify) . ... . . Dry Well <br /> Zoning Dist. ... .. . Conditional • • • • . . Seepage Trench ... • . . <br /> Land . .. . . . Privy <br /> 3. Lot Size 6. a exactly, 1- Seepage Bed l 4 9� :j n y <br /> x ft. fam. home, otel, etc.) FOR COMMERCIAL USE <br /> Plans Submitted . .... . :C: ► 1 <br /> . .. .. . . .. .. .. .... sq. ft. Plans Approved .. . .. . <br /> NOTE: A preliminary site inspection must be made and site approval granted on all strut- <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 of R <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 />