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o y z ( � <br /> Burnett County Office of Zoning Administrator S W <br /> APPLICATION FOR SANITARY — LAND USE = BUILDING PERMIT w <br /> To the Zoning Administrator: The undersigned hereby makes application for 1 . („ <br /> a 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, , :� f <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu. ( n <br /> lations of the State of Wisconsin. <br /> ft4e3�l�1Yl'..�'�.. G.k[lAl=l-j.T ��. ... ....... <br /> Owner or Agent (please print) Contractor or Surveyor J <br /> 3G5' Wicvvo'v*i+Vc wnITE <br /> Address. .......... ............. ........... 2 <br /> .. ............... .... .... .............. ... . . . <br /> Phone ^^' Phone <br /> L5. .. .... . . ... ................................ . ... ... c7 <br /> Plumber Well Driller <br /> !� ...... .. ............. .............. .... ...... ..... .... .. .... ... 2 S r".i <br /> Address Address S' <br /> Phone .... ........ .... Phone ........... ........ .. . <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities ; <br /> 1. Work (check one) Type of Construction No. Bathrooms . ..�. . •1 I <br /> New Building ..X.. RA�!�l�.... .. Dishwashers . ... .. <br /> Garbage Grinder ..... . :P <br /> Addition Size 1j.. ft. x -lr.- M. Autom. Laundry <br /> Sanitary . .T... ...... .� <br /> Alterations ...... Height ... . Stories .... No. Bedrooms <br /> Waste Disposal <br /> Moving - <br /> ...... .� <br /> Area .................. System ..... . <br /> Wrecking -•-••- Septic Tank Size <br /> Mobile Home . ..... 5. Permits Required - <br /> Privy . ... Gallons <br /> .- Subdivision H <br /> Well Sanitary ...x Absorption Field Site <br /> Subdivision Building Soil Type .4.,� 4.U... Z e <br /> X.. slope ... ..G.. .. ..Well r4 n 9 <br /> - Perc. Rate <br /> Other (Specify) '-+c- <br /> 2. Classification P y) Dry Well 'yam <br /> Zoning Dist. . ..... Conditional .•. Seepage Trench ... ... <br /> Land . ..... Privy, <br /> 3. Loot Size 8. Use (describe exactly, 1- Seepage Bed /�• ...SC� , . � <br /> M. ft. fam. home, motel, etc.) FOR COMMERCIAL USE <br /> % �if'/n l-l•,/ Plans Submitted . .. ... <br /> ... .............. sq. M. O'W 6GL•! /il C Plans Approved ... ... z: o <br /> NOTE: A preliminary site inspection must be made and site approval granted on all struc. . . 'i <br /> tures involving sanitary facilities before construction can begin. In the case of sewerage dis. h.�l <br /> posal systems, a copy of the percolation test moat be attached to this application before <br /> permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any 8 <br /> building until a permit has been issued. A permit may be revoked if misrepresentation of .P m <br /> any of the information conveyed herewith is found to exist. Changes in plans or specks. :rt <br /> tions shall not be made without approval of the Zoning Administrator. SEWER SYSTEM t:' <br /> SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br /> R�e <br />--- y I <br />