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a C <br /> 0 y z <br /> ist Burnett County Office of Zoning Administrator 6. g <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT "' :. <br /> To the Zoning Administrator: The undersigned hereby makes application for b ..--5 <br /> a Permit for the work described and located as shown herein. The undersigned agrees that i ' <br /> all work shall be done in accordance with the requirements of the County Zoning Ordinance, SJ 5_ <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- \P 1 <br /> lations of the State of Fisconsin. ;; <br /> .4.1/:.1 . ,1... ..4.X.V. -e <br /> j p..4.._ 4 l.f y.6 , /I <br /> wner or Agent (please print) Contractor or Surveyor ` <br /> rb <br /> it-ii7 /oril . 1- iv hi Ai 2 (1 , <br /> i le, ,e ,v <br /> Address Address :S <br /> Afr./41. -13.atjki.101-/ . rfri rt. 1.7`-1 55 2• 3 . <br /> Phone Phone <br /> Ce 3 4 - (, (-( (-4 v d R . <br /> Plumber Well Driller g <br /> Address Address SJ <br /> Phone Phone <br /> a. <br /> ai' ... <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities <br /> 1. Work (check one) Type of Construction No. Bathrooms IT\ <br /> New Building Dishwasher ... . ' r+ <br /> Garbage Grinder j <br /> AdditiSanitaryon Size ft. x ft. Autom. Laundry <br /> No. Bedrooms 41 <br /> 11P, <br /> Alterations Height ... . Stories .... Waste Disposal ij' <br /> Moving Area System m .5 <br /> Wrecking Septic Tank Size 1 <br /> Mobile Home 5. Permits Required Z. <br /> ,Gallons o' <br /> Privy Subdivision <br /> Well Sanitary Absorption Field/Site Tr.) <br /> Subdivision Building Soil Type : o <br /> Well Slope • . .5,..... <br /> 2. Classification Other (Specify) Perc.y Rate j <br /> Conditional Dry Well — •` <br /> Zoning Dist. -/- j Seepage Trench" <br /> Land ...> .. . Privy / <br /> 3. Lot Size 6. Use (describe exactly, 1- Seepage Bed �_ o <br /> ft x ft. fam. home, motel, etc.) FOR COMMERCIAL USE <br /> Plans Submitted %.,^' <br /> sq. ft. Plans Approved :3 iv <br /> ---( -j\H ' ---"t <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- :i <br /> posal systems, a copy of the percolation test must be attached to this application before a F gi <br /> permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any I <br /> al <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- `NJ — <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. 0 <br /> h <br />