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.,. , r <br /> L., <br /> d 0 p <br /> Burnett County Office of Zoning Administrator s. g <br /> o vl <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <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 Gr. <br /> all work shall be done in accordance with the requirements of the County Zoning Ordinance, tt p <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- •—J g <br /> lations of the State of Wisconsin. 43- <br /> .1 .41.(i.:ft.h.'ir �.) Lt <br /> . `f t `f 1 <br /> Owner or Agent (please print) Contractor or Surveyor <br /> (144cl 4 d. dV ►. Dr\i-ti` - E (GM. /111 i*r) h ,. s•-y/ ., <br /> Address Address rt <br /> T <br /> 5 <br /> Phone J Phone <br /> Plumber Well Driller <br /> 0 r <br /> Address Address <br /> TPhone Phone "� <br /> 1 . <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities <br /> 1. Work (check one) / Type of Construction No. Bathrooms r :1 ) <br /> New Building ..1.,;! Ff U Dishwasher <br /> Addition Garbage Grinder +C <br /> Sanitary (/-- Size . ft. x .-.5.�ft. Autom. Laundry . 0" <br /> Alterations Height . .. . Stories .,.. No. Bedrooms <br /> Waste DisposalCl <br /> Moving AreaSystem F <br /> Wrecking Septic Tank Size <br /> Mobile Home 5. Permits Required /c 0 0 Gallons ri' <br /> Privy Subdivisionr <br /> '✓"� � Absorption F`i�d Site f �' <br /> Well Sanitary Soil Type . . E.#1.. C� e' o <br /> Subdivision Building ✓�� is <br /> `�� Slope o a <br /> Well Pere. Rate to <br /> 2. Classification !'2)pit 0 Other (Specify) Dry Well ' 'N. <br /> Zoning Dist. Conditional Seepage Trench b 1 :b <br /> Land Privy /D n�/,.�K. - <br /> 3. Lot Size 6. - (descZibe exactly, 1- Seepage Bed 't t Y. . : oy <br /> ft. x ft. rcrl <br /> fam. home, motel, etc.) FOR COMMERCIAL USE 7) 1 <br /> �� Plans Submitted Er <br /> t �} <br /> sq. ft. Plans Approved 1 'd <br /> NOTE: A preliminary site inspection must be made and site approval granted on all struc- N. <br /> tures involving sanitary facilities before construction can begin. In the case of sewerage dis- ` (f <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 ins tall a septic tank, do any plumbing or start any oa <br /> building until a permit has been issued. A permit may be revoked if misrepresentation of (1) <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 G� <br /> SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. I <br />