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O s Z <br /> Burnett County Office of Zoning Administrator s <br /> e <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <br /> To tha Zoning Administrator: The undersigned hereby makes application for •\ 1�11i <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, :UI :vC <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu• <br /> lations of the State of Wisconsin. ,V1 rC ., <br /> L R <br /> zdk�V/PGS I�vFY C�ltM�j. ..C.E.C.IJ...SC!?.LPiPlE/� . ... ..... ... :� <br /> ... ............ ...... .. ...... ....... <br /> Owner:or Agent(please print) Contractor or Surveyor ; <br /> ...... ... ........ ..S jo.o.A t, e..wr:............. ... N <br /> Address Address <br /> . <br /> 6.3 S"-. ..37.yo..... .... .... ....... <br /> Phone Phone ' <br /> i_I ..SC�rr.1.. .... .... .. ....... .. .... .......: .... ...... ...... .. . <br /> Plumber Well Driller <br /> o <br /> C�'Jnr.. ....... .... .... .... ........ .... . ....... ........ . .. .. ..... g <br /> AAAress... Address H <br /> ..... ... ....... ....... ...... .hone......... .. ........ ...... .. ..... .... .... . <br /> Phone P <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities Z <br /> 1. Work (check one) Type/of/ConsWLction No. Bathrooms ly.ID. <br /> New. Building .. ... .:..C.,/.ls.C:^.. . ... Dishwasher ..... . . <br /> K. Garbage Grinder . .... . <br /> Addition <br /> Sanitary Size 1. ft. x .l.��ft. Autom. Laundry ..... . <br /> Alterations ...... Height ... . Stories ..., No. Bedrooms . .... . <br /> Waste Disposal <br /> Moving ... ... Area :.. .... .... .... .. . System <br /> . .. <br /> Wrecking ...... Septic Tank Size . . . , <br /> Mobile Home . .... . 5. Permits Required <br /> Privy ...... .... Gallons `^ <br /> Subdivision . ... <br /> Well Absorption Field Site C I! <br /> ... ... Sanitary ..X. Soil Type e <br /> Subdivision . .... ..... ... <br /> Building ...X.. � e <br /> . ..... Slope ....... ..... .... . <br /> Well <br /> Pere. Rate . .... ..... .. <br /> Other (Specify) g <br /> 2. Classification P y) _,,,,. Dry Well .. . .. . ti <br /> Zoning Dist. ...... Conditional _ ... ... Seepage Trench .. ... . <br /> Land <br /> Privy . .... . <br /> 3. Lot Size 6. Use (describe exactly, 1- Seepage Bed <br /> tL x tam. home, motel, etc.) FOR COMMERCIAL USE <br /> _ ft. Plans Submitted ... ... . <br /> ..1.�r.R.K . .. sq. ft. / 7"/1 rooms Plans Approved . .. ... 'e <br /> �r <br /> NOTE: A preliminary elle inspection must be made and site approval granted an all ¢true- <br /> tures involving sanitary facilities before construction can begin. In the case of sewerage dis. Z <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 install a septic tank, do any plumbing or start any w° <br /> building until a permit has been issued. A permit may be revoked if misrepresentation of o 14 <br /> any of the information conveyed herewith is found to exist. Changes in plans or specifics- 1I <br /> tions shall not be made without approval of the Zoning Administrator, SEWER SYSTEM QI <br /> SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. ;� N <br /> C> <br /> C>I <br /> o <br /> _ I <br />