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d.7') (' 'Y' <br /> C--"'""--- <br /> IV y <br /> Burnett County Office of Zoning Administrator 6' g <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT "' "1 <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 (i )) <br /> all work shall be done in accordance with the requirements of the County Zoning Ordinance, <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- e • <br /> r. <br /> lations of the State of Wisconsin. j CD <br /> 4,1 y <br /> & 4d. .. , /1 J7 <br /> Owner or Agent/ (please print) Contractor or Surveyor <br /> A 03 O.PIS.alVee": -t) y4 :1' <br /> Address Address <br /> Phone Phone <br /> P. <br /> Plumber Well Driller 3 I <br /> k4 i' <br /> Address Address 6 <br /> gPhone Phone <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities :/)1 <br /> 1. Work (check one) Type of Construction No. Bathrooms V <br /> Dishwasher <br /> New Building Garbage Grinder <br /> Addition Size ft. x ft. Autom. Laundry <br /> Sanitary No. Bedrooms <br /> Alterations Height . .. . Stories . ... Waste Disposal <br /> rrl <br /> Moving Area System <br /> Wrecking Septic Tank Size <br /> Mobile Home 5. Permits Required Z <br /> Privy x Subdivision Gallons rn <br /> Absorption Field Site �' <br /> Well Sanitary Soil Type1.Subdivision Building Slope o <br /> Well Pere. Rate <br /> 2. Classification _a Other (Specify) Dry Well . <br /> 't <br /> Zoning Dist. l Conditional Seepage Trench y� <br /> v3' <br /> Land Pri . • *ice <br /> 3. Lot Size 6. Use (describe exactly, 1- Seepage Bed y <br /> .70.. ft. x .0. ft. fam. home, motel, etc.) <br /> FOR COMMERCIAL USE <br /> o <br /> Plans Submitted <br /> sq. ft. ¶ Plans Approved �v <br /> NOTE: A preliminarysite inspection must be made and site <br /> p approval granted on all struc- <br /> turesQ <br /> involving sanitary facilities before construction can begin. In the case of sewerage dis- Q <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 <br /> aa <br /> building until a permit has been issued. A permit may be revoked if misrepresentation of 4, l <br /> any of the information conveyed herewith is found to exist. Changes in plans or specifica- <br /> turns shall not be made without approval of the Zoning Administrator. SEWER SYSTEM tiV <br /> SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. _ <br /> Q <br />