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I ! - ( ,' , l.l ' <br /> G y z <br /> go Burnett County Office of Zoning Administrator 5' g { <br /> o <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 •(,, <br /> all work shall be done in accordance with the requirements of the County Zoning Ordinance, 1 p <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu .;, <br /> - <br /> la ' s of the Sta f W' consin. � l I cD <br /> / 'V • <br /> ,e7 ent (pl p • t) IContractor or Surveyor <br /> Address Address • <br /> • <br /> • <br /> Phon��jjmee_ /G /V Phone •; <br /> t, 4-1 <br /> Plumber j Well Driller <br /> o <br /> Address Address r+ <br /> 0 <br /> Phone Phone oo <br /> c� <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities • %4 <br /> 1. Work (check one) Type of Construction No. Bathrooms •►,�;! v , <br /> New Building Dishwasher1'` <br /> Addition Garbagee Grinder <br /> Sanitary ( Size ft. x ft. Autom. Laundry <br /> Alterations Height Stories . ,,, No. Bedrooms <br /> MovingWaste Disposal <br /> Area System <br /> Wrecking Septic Tank Size � �' <br /> Mobile Home 5. Permits Required 7570. Gallons <br /> Privy Subdivision Absorption Field Site a Fe <br /> Well Sanitary Soil pe a: n <br /> Subdivision Building Slope g•• 0 <br /> Well Perc. Rate o .4• <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 'Cot/ ; y <br /> 0 <br /> ft. x ft. fam. home, motel, etc.) FOR COMMERCIAL USE g <br /> Plans Submitted co <br /> sq. ft. Plans Approved 'd - <br /> NOTE: A preliminary site inspection must be made and site approval granted on all struc- _ VU r <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 as <br /> building until a permit has been issued. A permit may be revoked if misrepresentation of 0 <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. �J <br />