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o <br /> Burnett County Office of Zoning Administrator 9 � c <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 :^C) <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- <br /> lations of the State of Wisconsin. r m <br /> ...... . ... .. . .... .. . . .. .. .. . . .. . . .. . .. . . . . .. . .. . ;S <br /> Owner or Agent (please print) Contractor or Surveyor <br /> �t.d.../V� r7/ti. . .P{.a.':�,. . S. . ..et/VF.r.t. k. l/5. ...�Uf <br /> Address Address �f <br /> ....1.�o?.. . . .... .. . . .. ... . .. y► ? <br /> Phone , Phone <br /> ?..�.. .. .. ... . . . . .... .. .... .... . . ... . .. . ... .... .. . . . . . . . . . <br /> Plumber Well Driller < !y <br /> . .. ... . .. . . .. . .. .. <br /> . . <br /> %V <br /> Address Address , <br /> p .. .. . . . <br /> PhonePhone <br /> n <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities <br /> 1. Work (check one) Type of Construction No. Bathrooms . .. �. . <br /> )(� Dishwasher . . . .. . <br /> New Building Garbage Grinder . .. .. . <br /> San ition trig . ..i. ft <br /> Size . . . .. . x . . . . . ft. Autom. Laundry <br /> . ..... <br /> No. Bedrooms <br /> Alterations ...... Height ... . Stories .... Waste Disposal <br /> Moving ... . <br /> Wrecking Area .. . .. ... . .. .. . . .. • Septic Tank Size <br /> Mobile Home . .. ... 5. Permits Required p <br /> Priv .. . ... Gallons m <br /> Subdivision SP <br /> Absorption Field Site _ E. X <br /> Well ... .. . Sanitary • •� Soil Type . Ira�yoo " : R• <br /> Subdivision Building . . . Slope . .. . . .`L, .67.0* <br /> /.4.. . : ty <br /> Well • • •••. Pere. Rate <br /> (Specify)Other (S <br /> 2. Classification P Y) .. ... . Dry Well <br /> Zoning Dist. . ..... Conditional ... .. . Seepage Trench . . . <br /> Land ... . . . ... <br /> Privy <br /> 3. Lot Size 6.�be exactly, 1- Seepage Bed <br /> ft. x ft. fam. h_ omejmotel, etc.) FOR COMMERCIAL USE <br /> Plana Submitted M <br /> f .S1 <br /> P.0. 1 . sq. ft. Plans Approved . .. .. . 'V <br /> � QJ <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 � SL <br /> permit will be issued. Do not purchase or install 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 <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 /> 4 <br />