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d ,- z <br /> Burnett County Office of Zoning Administrator s. g <br /> 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT `" <br /> : t <br /> To the Zoning Administrator: The undersigned hereby makes application for V <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, —7---. o <br /> V\ <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- p <br /> lations of the State of Wisconsin. 0 <br /> 02bo .tJ E - --AQ 14AiS0."t/ <br /> Owner or Agent (please print) Contractor or Survey r 1 t <br /> 1/9 72_ 15 L 0,J 4/ --- lies , rr f <br /> Address Address C. W <br /> \ <br /> Phone Phone de <br /> Plumber Well D7(7 ' i 4 C <br /> Address Address e <br /> Phone Phone <br /> TJ <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities <br /> Type of Construction No. Bathrooms <br /> 1. Work (check one) Dishwasher ' <br /> New Building Garbage Grinder -‹ <br /> Addition Size ft. x ft. Autom. Laundry 4�n <br /> Sanitary No. Bedrooms :"'1 <br /> Alterations Height . .. . Stories .... Waste Disposal <br /> Moving Area System \ it <br /> Wrecking Septic Tank Size <br /> Mobile Home B. Permits Required I <br /> (�Privy Subdivision GallonsDc <br /> Absorption Field Site <br /> Well SanitarySo " <br /> Subdivision Building Slope 'Pe o'i. a Cell Pere. Rate p <br /> 2. Classification er (Specify) Dry Well <br /> Zoning Dist. Conditional Seepage Trench t <br /> Land Privy C <br /> 3. Lot Size 6. Use (describe exactly, 1- Seepage Bed c <br /> x fam. home, motel, etc.) FOR COMMERCIAL USE <br /> ftae ;e{,CJ) , Plans Submitted <br /> /!✓ Plans Approved .o 6 <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- N <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 ins tall 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 es <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 />