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d y z <br /> Burnett County Office of Zoning Administrator g <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, p <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- <br /> lations of the State of Wisconsin. f eo <br /> Owner or Agent (please print) Contractor or Surveyor +' :1L <br /> 3 r.C�. ..� 7X?47:)O..... ..... . C�. ?9? `r7 t�12� ':L►� <br /> Address Address :ly <br /> . .. .. . . .. .. . . .. .. . . . . . . . . ...... .. .. . . 1 , : A <br /> Phone Phone . . . . . . . . . <br /> . .. .. .. . . .. .. . . . ........... ..... . . . . . . . ................ .... .. .. . <br /> PlumberWell Driller <br /> < ; <br /> c <br /> Address. . . . . .. . . .. ....................... . . . . . . . .. . ............... .. . .. .. .. . <br /> Address : X� <br /> .. . . .. . . . . . . . . .. ...... ....... . .... . . . . . . . . . .. . . . . . . . . .. . . . . .. . . . . . .. . . . <br /> PhonePhone <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities <br /> 1. Work (check one) Type of Construction No. Bathrooms <br /> New Building jS . . ?'I?I Dishwasher . . . . . . : .. <br /> Garbage Grinder . . . . +r <br /> Addition . .... . Size .;-t ft. a .. ft. Autom. Laundry <br /> Sanitary . � . No. Bedrooms �!<. . <br /> Alterations Height . :}. . Stories .�. : Waste Disposal G f <br /> Moving .. . .. . Area . . . .. . . . . . . . . . System <br /> Wrecking ...... tic Tank Size <br /> Mobile Home . . ... . 5. Permits Required q .`I�,7.T .. Gallons �' <br /> WellPrivSanSubdia Sion Absorption Field Site ' <br /> Well .1 • Sanitar xc. Soil Type . .. .. `2�? � :0 c <br /> Subdivision • • • • • • g pe :t`N <br /> Slope c d <br /> Well . Pere. Rate . ...... &. :� p <br /> 2. Classification Other (Specify) ...... Dry Well <br /> ZoningDist. �fa.-. Conditional ...... <br /> 1 Land Seepage Trench . .... . :� :? :01-z <br /> Privy J <br /> 3. Lot Size 6. U�describe exactly, Seepage Bed . , y <br /> l <br /> ft. fam. Tome motel etc.)pe` f< S �G. FOR COMMERCIAL USE <br /> Plans Submitted <br /> .4� ... sq. ft. ��' � Plans Approved . . . . . . b <br /> NOTE: A preliminary site inspection must be made and site approval granted on all <br /> 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 m ust be attached to this application before a <br /> permit will be issued. Do not purchase or instal, a septic tank, do any plumbing or start any <br /> building until a permit has been issued. A permit may be revoked if misrepresentation of :p <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 />