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p . _. A <br /> r/ . <br /> 'l 4+ <br /> d c c <br /> A{ <br /> IAS Oek Burnett County Office of Zoning Administrator g g 1 <br /> O 1 <br /> o, (APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT �M <br /> r o0 <br /> To the Zoning Administrator: The undersigned hereby makes application for 1 <br /> R 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, A o <br /> �� Sanitation Code, and with all other applicable County Ordinances and the laws and regu- — „ a <br /> lati ns of the State of Wisconsin.f/ S 01 <br /> q P ° 1 /L/ )&71 Y r( <br /> Owner or Agent (please print) Contractor or Surveyor <br /> /S' '7$ h'n 0 j 44) v 7 <br /> Address .i S i o 4 Address LA; G <br /> 7 7/ 9 6 y ,A <br /> Phone Phone <br /> IV/�L C <br /> Plumber Well Driller a F <br /> Address Address <br /> �I • r <br /> Phone Phone <br /> i <br /> :5 <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities <br /> 1. Work (check one) Type of Construction No. Bathrooms 1 <br /> Newddress - • <br /> 1/ A Dishwasher <br /> Garbage Grinder <br /> Addition Size . .Li.a. . ft. x . .`j ft. Autom. Laundry <br /> Sanitary . .(..:: No.. Bedrooms . .)-- <br /> Alterations Height . .. . Stories .... Waste Disposal 01 <br /> Moving Area System <br /> Wrecking Septic Tank Size <br /> Mobile Home 5. Permits Required c O ti <br /> Privy .-.7 .....'... Gallons <br /> Subdivision Absorption Fiej4Site °' ' <br /> Well Sanitary •.4-r"."--- Soil Type J 5�5: 4 <br /> Subdivision Building Slope y O. <br /> Well Pere. Rate is <br /> 2. Classification P?-2Other (Specify) Dry Well <br /> Zoning Dist. Conditional Seepage Trench <br /> Land Privy <br /> 3. Lot Size 6. Use (describe exactly, 1- Seepage Bed l.�.X/v c <br /> t9 ° ftx a ° t1 ft. fam. home, motel, etc.) FOR COMMERCIAL USE p <br /> ,� Plans Submitted °' <br /> sq. ft. / /� --`'‘''.4 <br /> Plans Approved v <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 <br /> systems, a copy of the percolation test must be attached to this application before ar. <br /> permit will be issued. Do not purchase or ins tall a septic tank, do any plumbing or start any as <br /> building until a permit has been issued. A permit may be revoked if misrepresentation of ep <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 f <br /> SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />