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Burnett County <br /> APPLICATION FOR,SANITARYI Office�`of�%ning' d <br /> LAND E✓/ _6U�l SK*71strafor Q 01 2 <br /> To thelZoninp. Adminlatra}er: ��e.uttdetai -BUILD <br /> " D,"Ai, <br /> a Permit for the work described and'located as shown h rh un A "" 1T ;� runt <br /> all work shat] e, done in ec211 other with the.asgSb emeats;ot'the r ��'�d a�4ori Or <br /> ~ 1 <br /> Sanitation Code, and ,with all other aypllcableCounty Ordln: `'�'�ragOiq\y�t . <br /> lotions of the State of Wisconsin \ <br /> Ir or Agent (please print) Contrac ar or Surveyor t�r� F <br /> Address .. .... ...... ....... .............. .... . ' <br /> Address r �' � .: '�1;7/. • __ . _ <br /> Ph <br /> 111111y, •� Phone <br /> .. . .. .. .... .... .. ...... .. .... . .. <br /> Plumber well, Driller �Hg � <br /> . ....... .. .. ...... ... ... ... ............. ... . ... ... . .... .......... . .. ...... . \. \ <br /> Address <br /> Address" <br /> s •• <br /> Phone <br /> Phone <br /> ' <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities <br /> f <br /> oConstruction No. Bathrooms a- S .1 <br /> 1. Work (check one) Type of • <br /> New Building .,{Q' ^ - Dishwasher ..... . <br /> .. ...r.9.Y: ^.`...... .. .. <br /> Addition Garbage Grinder ..... . <br /> cp <br /> Size aS . ft, x . /Aft. Autom. Laundry . ..... `i <br /> Sanitary. Al <br /> Alterations ...... Height ... . Stories . ... No. Bedrooms . .. .. . <br /> Moving Waste D <br /> isposal <br /> Area . .......... ..•� �' � System . . . .. . . <br /> Wrecking .... <br /> v, .n <br /> Septic Tank Sze <br /> 3lobile Home ...... 5.-Permits RequiredI <br /> Privy . .•••• Subdivision 0. ... Gallons� :) I <br /> Well Sanitary �� Absorption Field Site. ' <br /> Subdivision ...... Soil Type �... <br /> Building Slope ... <br /> 2. Classification Well . 11 Pere. Rate <br /> Other (Specify) Dry Well <br /> Zoning Dist. ...... Conditional ...... Seepage Trench <br /> 6 <br /> ... ... Privy <br /> ... ... e _ <br /> 3. Lot Size 6. Us vibe exactly, 1 Seepage Bed l r�A'3.r 01 CS <br /> ....:.. ft. x ...... . ft. <br /> tam, home motel, etc.) FOR COMMERCIAL. USE 1 <br /> ` ' n Plans Submitted . ..... E [� <br /> . .Y .4JC!rF.-4- aq. ft. Plans Approved ...... 'e <br /> "R O <br /> NOTE: A preliminary. site inspection must be made and site a \ <br /> p ry ape 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 m <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 /> � c�(`(,�l�S.,/em jeno.xq S`Jru /l4ure 1Rfi/_��y / ! ke-55 I''r I�GQ • / /')li.S : . ./ <br /> 1 I ` `^.C� vre I%ad !I beery Oou UC'rl QGl 'I�J Ili��1IIS[y � C✓ q <br /> /M* �rs Scott tom uo?_OA�,l �f Urhr Tm� <br /> G.el4r, <br />