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- . ( L5') ({ iy) <br /> AY V <br /> Burnett County Office of Zoning Administrator r g <br /> 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT • <br /> To the Zoning Administrator: The undersigned hereby makes application for 7 <br /> es <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- 1 <br /> lations of the Stat f Wisconsini <br /> r� e' .� •.1.-.--7---1,- 1--211-(-------- cl)-) '''' •,-',,( ' <br /> Owner or Agentlease p • t) Contractor or Surveyor <br /> Address Address k. <br /> Phone Phone <br /> Plu be Well Driller a`. 1\ <br /> .Z:eit•/-ie-12 447rx,3 a a-.• \ . <br /> Address Address 1. <br /> • <br /> Phone Phone , vir <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities %v <br /> 1. Work (check one) Type of Construction No. Bathrooms <br /> New Building x,; ,,, Dishwasher "" <br /> Addition .. Garbage Grinder <br /> Sanitary Size ft. x ft. Autom. Laundry <br /> Alterations Height ... . Stories .�'•. No. Bedrooms <br /> Waste Disposal <br /> Moving Area System rw <br /> Wrecking Septic Tank Size <br /> Mobile Home 5. Permits Required '"'C UV <br /> •..: &•Cs Gallons rn <br /> Privy Subdivision / a' <br /> ,( Absorption Field Site co <br /> E a: Z I <br /> Well Sanitary / Soil Type S €7 <br /> Subdivision Building !�• Slope O (j) <br /> Well Pere. Rate <br /> 2. Classification Other (Specify) Dry WellN. y, <br /> Zoning Dist. IC�onndditional Seepage Trench V <br /> Privy , _ji <br /> 3. Lot Size 6. Use (describe exactly, 1- Seepage Bed- 7 ,/7 o O <br /> fam. home, motel, etc.) FOR COMMERCIAL USE • , ,` <br /> ft. x ft. Plans Submitted Ili <br /> sq. ft. Plans Approved \- u I <br /> `C D <br /> 5NOTE: 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 oa <br /> building until a permit has been issued. A permit may be revoked if misrepresentation of . N <br /> any of the information conveyed herewith is found to exist. Changes in plans or specifics- , • <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. U <br />