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en 7V <br /> C.a...., <br /> Burnett County Office of Zoning Administrator g g <br /> -.... <br /> � <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT ;SLS <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 izis <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- -t f p <br /> lations of the State of Wisconsin. .. p y <br /> r -v ?- e yy��� 5'cll 61C1S171;-"e11-771. <br /> Owner or Agent (please print) Contractor or Surveyor V <br /> Address fri ,4 6 fit, e 2 �. .,,� ./ Address .�, <br /> Phone Phone <br /> 7— <br /> rN if'Q/11-/ T cy • <br /> Plumber . Well Driller eg < r <br /> E tit Sf a <br /> Address Address s , <br /> Phone Phone 0 <br /> .� <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities r <br /> 1. Work (check one) Type of Construction No. Bathrooms <br /> Dishwasher �., <br /> New Building Garbage Grinderav <br /> Addition Size ft. x ft. Autom. Laundry <br /> Sanitary .?S.. No. Bedrooms •� <br /> Alterations Height ... . Stories .... Waste Disposal <br /> Moving Area System <br /> Wrecking Septic Tank Size <br /> Mobile Home 5. Permits Required Gallons �' & <br /> Privy Subdivision o <br /> Absorption Field Site W <br /> Well Sanitary . ?1. . " e: a ..Z., <br /> ' <br /> Subdivision Building Soil Type o <br /> Slope ocs <br /> Well Perc. Rate <br /> 2. Classification Other (Specify) <br /> Zoning Dist. Land <br /> dditional Seepage Trench <br /> ` , ( <br /> Privy <br /> 3. Lot Size S��,-4 t,c. Pe*/ 6. Use (describe exactly, 1- Seepage Bed i dy <br /> o <br /> fam. home, motel, etc.) FOR COMMERCIAL USE �'� ` <br /> ft. x ft. 2p� Af-t`i r, Plans Submitted I� X�• . <br /> sq. ft. Plans Approved ]C -..� 'el <br /> ll • <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 /> b <br /> posal systems, a copy of the percolation test must be attached to this application before a r. <br /> permit will be issued. Do not purchase or ins tall a septic tank, do any plumbing or start any r oa <br /> building until a permit has been issued. A permit may be revoked if misrepresentation of o <br /> any of the information conveyed herewith is found to exist. Changes in plans or specifica • <br /> - <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. Y i" <br /> Gi <br />