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a <br /> Burnett County Off Ice of Zoning Administrator � <br /> L o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT _ <br /> To the Zoning Administrator: The undersigned hereby makes application for 'it ( i �-.� <br /> a Permit for the work described and located as shown herein. The undersigned agrees that (e <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 /> C <br /> lations of the State of Wisconsin. <br /> (..... <br /> .. ...... . .. ... .. . ... ... .. . . . :�! V <br /> Owner or Agent (please AL) Contractor or Surveyor. <br /> �ghp`i .. .W`. . . . <br /> Address Address <br /> .. .. .. ......... ...... .... .. . . ...... . . .. . <br /> Phone Phone <br /> j <br /> , / . .�✓.. . .. .. .. ... . ..... ...... . ....... .... .... . . .. . . .. . . . <br /> Plumber Well Driller <br /> Address Address <br /> .... . ... ... .. <br /> Phone Phone <br /> :1 <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities <br /> Type of Construction No. Bathrooms " " <br /> 1. Work (check one) � •m <br /> I� Fn 4 �r Dishwasher . .. ... ,r , <br /> New Building Garbage Grinder <br /> Addition ...... a a b g ... ... <br /> :' <br /> Size l'. ft. x ft. Autom. Laundry .. <br /> Sanitary . <br /> Alterations ...... Height ... . Stories .... Waste Disposal T (A} <br /> Moving .... Area System :rn JCI <br /> Wrecking ...... Septic Tank Size <br /> Mobile Home . .... . 5. Permits Required <br /> ..l 2 d.0 ... Gallons m <br /> Privy Subdivision •• Absorption Field Site <br /> Well . Sanitary v Soil . .. ... .. ... <br /> Subdivision ... ••• Building •� Slope . .... .. .. . .. . °u <br /> Well l.� Pere. Rate . . .. Lr- <br /> 2. Classification ^^ Other (Specify) ..... . Dry Well <br /> Zoning Dist. RA-7 v Conditional . .... • Seepage Trench . . . ... <br /> Land . .. . . . privy I <br /> 3. Lot Size 6. Use (describe exactly, 1- Seepage Bed ;?`/h J.V c <br /> Y fam. home, motel, etc.) FOR COMMERCIAL USE <br /> /.�F'. ... ft. x ...... , ft. Plans Submitted . ;A\ <br /> ..A Gr,s h. . sq. ft. 1 Plans Approved . ..... <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 10 <br /> any of the information conveyed herewith is found to exist. Changes in plans or specifics- <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 />