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of,---77e&---,yei. <br /> .- <br /> 6_,_ <br /> d o p <br /> Burnett County Office of Zoning Administrator T 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, ` 4,, p <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- g <br /> la of the State o Wisconsin. ) `D, <br /> Own r Age (please print) .,/a/u,6(2 wariv <br /> Contractor or u eyo •,.., <br /> Address Address <br /> Phone Phone <br /> G <br /> Plumber Well Driller 1 <br /> si r q <br /> Address Address S <br /> Phone Phone R <br /> DESCRIPTION 4. Building Details 7. Sanitary P.cilities <br /> T... <br /> 1. Work (check one) Type of Construction No. Bat ooms fi <br /> Dishw. her 4?„.New Building Garba e Grinder <br /> Addition Size ft. x ft. Auto Laundry <br /> Sanitary No. B•'rooms :,,4.5 <br /> Alterations Height .... Stories . ..• Waste isposal t'� <br /> Moving Area System I <br /> Wrecking Septic Tank e <br /> Mobile Home 5. Permits Required �.�' allons 1 g <br /> Privy Subdivision Absorption Field S • :9 J : g' <br /> Well Sanitary Soil Type Ty • o <br /> Subdivision ..4':.. Building Slope o• a <br /> Well Pere. Rate ` p <br /> 2. Classification Other (Specify) , Dry Well <br /> Zoning Dist. Conditional Seepage Trenc ,)% •�' <br /> Land Privy !. <br /> 3. Lot Size 6. Use (describe exactly, 1- Seepage Bed )63 <br /> fam. home, motel, etc.) FOR CO 1 IN,'CIAL USE '',. <br /> ft. x ft. d <br /> Plans Submit'•d 1 V. <br /> sq. ft. Plans Approve, 'd <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 ea <br /> building until a permit has been issued. A permit may be revoked if misrepresentation of A <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 />