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' ON COMPUTER/SCANNED C_-- <br /> G y <br /> Burnett County Office of Zoning Administrator S' g . <br /> M <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 I 4 '`� <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 /> lations of the State of Wisconsin. ( W <br /> Owner or Agent (please print) Contractor or Surveyor <br /> VAIN 8v ) G�.r rf no <br /> Address Address <br /> Phone Phone <br /> 4 <br /> Plumber Well Driller CD <br /> a. <br /> 0 4' <br /> Address Address �, <br /> 0 <br /> zy 37 4 <br /> Phone Phone ,0 <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities <br /> 1. Work (check one) Type of Construction No. Bathrooms .1 . <br /> New Building ,tDishwasher-. V \ <br /> Garbage Grinder <br /> Addition Size ft. x ft. Autom. Laundry 'V <br /> Sanitary . .,).0. g No. Bedrooms . .& C/► 1 <br /> Alterations Height . .. . Stories . ... 01 <br /> Waste Disposal 1_ <br /> Moving Area System <br /> Wrecking Septic Tank Size <br /> Mobile Home 5. Permits Required <br /> 7$-z2 Gallons <br /> Privy Subdivision Absorption Field Site o. g) <br /> Well Sanitary Soil Type ...0. , E <br /> Subdivision Building Slope I o - <br /> Well Pere. Rate ° <br /> 2. Classification Other (Specify) Dry WellII N <br /> Zoning Dist. Conditional Seepage Trench . (4 , <br /> Land Privy <br /> 3. Lot Size 6. Use (describe exactly,(__ Seepage Bed f2 y <br /> 0 <br /> lam. home,1inotel, etc.) FOR COMMERCIAL USE g <br /> ft. x ft. Plans Submitted <br /> S sq. ft. Plans Approved '� <br /> Too a FRo,vtqlt <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 d <br /> permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any ea <br /> building until a permit has been issued. A permit may be revoked if misrepresentation of o <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 />