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\____ <br /> C ,- z <br /> Burnett County Office of Zoning Administrator 8 g <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT Ci " ..... <br /> n <br /> To the Zoning Administrator: The undersigned hereby makes application for '`Q <br /> a Permit for the work described and located as shown herein. The undersigned agrees that -_. h <br /> all work shall be done in accordance with the requirements of the County Zoning Ordinance, n p <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- -s % <br /> lotions of the State of Wisconsin. y <br /> 0 u r- 11-3 c "4:- it. e, 1-- <br /> i'a 7' (3 Q s i t-r <br /> ) -,, <br /> Owner or Agent (pleaseprint) Cont for or Surveyor '`"gY <br /> Address Address i --.1*" <br /> Pho Phone t , <br /> v , rilS cy `' <br /> Plu er Well Driller i .4 .3.---, <br /> re 7 <br /> Address Address <br /> S <br /> Phone Phone <br /> DESCRIPTION 4. BuildingDetails 7. SanitaryFacilities ��'` <br /> 1. Work (check one) Type of Construction No. Bathrooms r i?l <br /> New Buildin Dishwasher ' <br /> Addition g Garbage Grinder +C <br /> Size ft. x ft. Autom. Laundry <br /> Sanitary �-r No. Bedrooms <br /> Alterations Height . .. . Stories .... Waste Disposal i1 <br /> Moving Area System <br /> Wrecking Septic Tank Size <br /> Mobile Home 5. Permits Required a / 1.0 v, N...Gallons <br /> Privy Subdivision Q3 <br /> Absorption Field Site <br /> Well Sanitary Soil Type 5 R <br /> Subdivision Building Sloped I. p <br /> Well Perc. Rate A p <br /> 2. Classification 2.pp�A Other (Specify) Dry Well g-* k. <br /> Zoning Dist. /.J.. ./.� Conditional Seepage Trench U <br /> LandPrivy 1 <br /> 3. Lot Size 6. Use (describe exactly, 1- Seepage Bed 2.tf.X.a2 ..;3 (J <br /> f,1. home motel, etc.) FOR COMMERCIAL USE K <br /> ft. x ft. 1.w Plans Submitted E <br /> i. <br /> 6"�-2--� sq. ft. / C G / Plans Approved -Q 'o <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 ins tall a septic tank, do any plumbing or start any .15 <br /> building until a permit has been issued. A permit may be revoked if misrepresentation of DUci <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 /> F <br />