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O H 2 <br /> Burnett County Office of Zoning Administrator S P <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <br /> To tho Zoning Administrator: The undersigned hereby makes application for <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, p <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- e <br /> lotions of the State of Wisconsin. <br /> .N; <br /> Owner or Agent (please print) Contractor or Surveyor i ftj <br /> • � Jl] <br /> W. Lau. .. .Wib. .. ..... .... . . .. .................... .... ... .... .... ... <br /> Address Address _ <br /> ..... .... ../JL'.lJ ..... ... . . :\� <br /> . ........... <br /> Phone Phone..:... ... .... ....... ....... .. .... . ...... <br /> tv <br /> - Plumber Well Driller-�� � <br /> ... .......... .... ................... ...... .... ................... .... ..... <br /> Address <br /> S- <br /> Phone Phone n :a <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities' <br /> 1. Work (check one) Type of Construction No. Bathrooms ...�.. S <br /> Dishwasher . .... . <br /> New Building ..... •• AfD•:kfC U77K. Garbage Grinder . .... . is <br /> Addition .•h. Size .A y ft. x 107. ft. Autom. Laundry . .25.•. <br /> Sanitary . . No. Bedrooms <br /> Alterations ,,,... Height J. . Stories .4�. Waste Disposal <br /> Moving ...... Area System . .. .. . "'I v <br /> . Wrecking ...... ......... ......... Septic Tank Size I <br /> y <br /> Mobile Home . ..... 5. Permits Required <br /> Privy ...... Subdivision .. ... ... ... . Gallons y <br /> Well Sanitary •J'S.. Absorption Fiecld• Site .i <br /> Soil Type <br /> Subdivision ...... Building x• Slope . — R <br /> c Pere. Rate . ... . ... <br /> Other (S g ` (I� <br /> 2. Classification (Specify) ...... Dry Well . . ... . :v <br /> Zoning Dist. . ..... CoonnddW <br /> itional . .... . Seepage Trench .. .... :� � 2 <br /> Privy <br /> 3. Lot Size 8. Use (descn exactly,C Seepage Bed <br /> am. ome taaW...aie.) FOR COMMERCIAL USE <br /> !4.. n. x .`fQ ft. Plans Submitted ...... <br /> . ... . .. I ... ...... sq. ft. Plans Approved . .. .. . ;f�jb�•� : 'o G <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 A C <br /> building until a permit has been issued. A permit may be revoked H.misrepresentation of n <br /> any of the information conveyed herewith is found to exist. Changes in plans or speci£ma. <br /> tions shall not be made without approval of the Zoning Administrator. SEWER SYSTEM _ 1 <br /> SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. 'n <br />