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G '- z <br /> Burnett County Office of Zoning Administrator g 0 <br /> 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT `, :i <br /> To the Zoning Administrator: The undersigned hereby makes application for 1 t-'C <br /> a Permit for the work described and located as shown herein. The undersigned agrees that 1 ' <br /> all work shall be done in accordance with the requirements of the County Zoning Ordinance, v 0 <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- , a <br /> lations of the State of Wisconsin. .J 1"1: 4 <br /> cr <br /> Dn-i-& E, ..1--4/1. F..it/ Ai0gTiiL4-I', 6i)iLD 4 \ ' • <br /> Owner or Agent (please print) Contractor or Surveyor <br /> Address ! Address <br /> Phone Phone <br /> Plumber Well Driller e t <br /> g <br /> Address Address � <br /> S <br /> Phone Phone Ng <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities ..e- <br /> 1. Work (check one) <br /> Type of Construction No. Bathrooms i r :F <br /> OF • Dishwasher <br /> New Building v <br /> C Garbage Grinder +C <br /> Addition Size ft. x ft. Autom. Laundry <br /> Sanitary No. Bedrooms .x <br /> Alterations Height . . . . Stories . . .. Waste Disposal Co 5 <br /> Moving g Area System <br /> Wrecking Septic Tank Size O' <br /> Mobile Home 5. Permits Required _ . . Gallons ril< <br /> Privy Subdivision Absorption Field Site R--if <br /> Well Sanitary <br /> Subdivision Building r':( Soil Type c <br /> Slope `LJp <br /> Well Pere. Rate <br /> 2. Classification Other (Specify) Dry Well O(-* <br /> Zoning Dist. 1\ CCoondditional Seepage Trench 0:.--\ V <br /> Privy <br /> 3. Lot Size 6. Use (describe exactly, 1- Seepage Bed y <br /> fam. home, motel, etc.) <br /> ft. x ft. FOR COMMERCIAL USE <br /> F'450,idii t— die N1 E E?'Plans Submitted _� <br /> sq. ft. Plans Approved 'ti <br /> NOTE: A preliminary site inspection must be made and site approval granted on all struc- �''r 93 <br /> tures involving sanitary facilities before construction can begin. In the case of sewerage dis- -, W <br /> posal systems, a copy of the percolation test m ust be attached to this application before a gj <br /> permit will be issued. Do not purchase or ins tall a septic tank, do any plumbing or start any o1a <br /> building until a permit has been issued. A permit may be revoked if misrepresentation of e11, <br /> any of the information conveyed herewith is found to exist. Changes in plans or specifica- -., (Al <br /> tions shall not be made without approval of the Zoning Administrator. SEWER SYSTEM 3' <br /> SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />