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0 0 0 <br /> Burnett County Office of Zoning Administrator i g <br /> !\ M <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <br /> To the Zoning Administrator. The undersigned hereby makes application for ;O7J <br /> a Permit for the work described and located as shown herein. The undersigned agrees that r d <br /> all work shall be done in accordance with the requirements of the County Zoning Ordinance, E <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- <br /> lations of the State of Wisconsin. <br /> Owafor (please print) Contractor or Surveyor : <br /> !. . . . ... .. . .. . .. .. . ..... .. .. .. .... .................. <br /> Address Address <br /> .... .. ... ..... ...... .. .. ...... ... . ........ .. ... .. ...... .. .... .. . . .. .. .. ... . . : ► > <br /> Phone Phone : <br /> Plumber �� A Well Driller <br /> �..S.W"f 5, . ..... .... .... . .. . .. .......... . .. . . .. .... . <br /> Address oo Address <br /> G `f.0... 41..... ..... .. .. .. .. . ..... .. .. .. . . .. .. .. .. .. .... . .... ... ... .. . <br /> Phone Phone <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities <br /> 1. Work (check one) Type of Construction No. Bathrooms . . . .. . <br /> Dishwasher <br /> New Building Garbage Grinder . .. .. . <br /> Addition ft. x .. .. . ft. Autom. Laundry . ... .. <br /> Sanitary No. Bedrooms . .... . <br /> Alterations ...... Height ... . Stories . ... Waste Disposal <br /> Moving ..... . Area System ... .. . <br /> Wrecking ...... . .. .. .. .. .. . Septic Tank Size <br /> Mobile Home . .. ... 5. Permits Required <br /> . . . .. .. .. . . ... <br /> Gallons °1 <br /> Privy . •••• • Subdivision /• Absorption Field Site <br /> Well ••• •• • Sanitary Soil Type . . <br /> Subdivision Building Slope °n <br /> Well ... .. , Pere. Rate . . .. <br /> 2. Classification Other (Specify) ...... Dry Well . .. .. . <br /> Zoning Dist. ...... Conditional • •• •• • Seepage Trench . . .. . . <br /> Land Privy . .. .. . <br /> 3. Lot Size 6. Use (describe exactly, 1- Seepage Bed ... .. . e <br /> fam. home, motel, etc.) FOR COMMERCIAL USE : <br /> .. ..... ft. x . . .. .. . ft. Plans Submitted . .... . � o <br /> . . ... .. .. . ... .. .. sq. ft. Plans Approved . .. ... <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 : <br /> building until a permit has been issued. A permit may be revoked if misrepresentation of <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 "( <br /> SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br /> 7 3 /� y/7�� 9 a 9 <br />