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moo <br /> Burnett County Office of Zoning Administrator S <br /> • APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <br /> To the Zoning Administrator: The undersigned hereby makes application for Q <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, <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- <br /> lations of the State of Wisconsin. <br /> +.�F.v^!...3-0.... ..... 5/�. <br /> Owner 1 gent des pr' 0 /!5 lion actor or Surveyor V - <br /> ... SYS .. '\ <br /> .. ....... . .... . rxt .:. .... ..:. ......... .... . <br /> Address.. .. ..... Address f <br /> 8. ti-c..... .. ..".... .. ... .... <br /> ... .. .. ...... .... ........ ..... ... . <br /> Phone Phone SS <br /> ... ........ .... .... .. .......:. ... ..... ... ..::. .. ..... ... . . .. . . . C <br /> Plumber _ Well Driller m <br /> e�.?1 �..IIoX.Sf.z11, SllPe +i o \ <br /> G <br /> .. .. . . .... .. .. ........ .... .... .... .... ..... ... . .... ... B .. u <br /> Address Address :L <br /> ........ ........ ...... .... .... .. ...... .................... <br /> . Phone Phone <br /> 2 <br /> DESCRIPTION 4. Building Details i. Sanitary Facilities .� <br /> 1. Work (check one) Type of Construction No. Bathrooms <br /> Dishwasher . .... . C .. <br /> New Building ..t� .fv.K Wt.?.—.... ..-... <br /> Addition Garbage Grinder ... . <br /> Sanitary <br /> ""/'- Size ?-<•. . ft. x .yf( ft. Autom. laundry <br /> Alterations v.. Height . ... Stories .... No. Bedrooms <br /> Waste Disposal <br /> Moving ..... <br /> ,,, ,, , ?a <br /> Wrecking ...... Area . .... .... .... .... . SystemSeptic Tank Size . <br /> Mobile Home ..... . 5. Permits RequiredPrivy „ �.L.V.d..... Gallons c <br /> Well ..1/._ Subdivision Absorption Field Site <br /> .. ... <br /> Sanitary .. <br /> Subdivision .. . ... Building 4/ Soil Type ............. <br /> , J' Slope .... .... .... .... . <br /> Well .. <br /> Pere. Rate . .. .. .... ... <br /> Other (Specify) :C 5 <br /> 2. Classification P Y) ... ... Dry Well . .... . <br /> Zoning Dist. ...... Conditional .. . ... Seepage Trench . A '\ <br /> Land ... ... Privy q�.> <br /> 3. Lot Size 6. Use (describe exactly, CL Seepage Bed <br /> �./�.. ft. x L! L° ft. fam. home, motel, etc.) FOR COMMERCIAL USE <br /> Plans Submitted ... ... E i. <br /> . 7.`�.{-.q . .. . . sq. ft. <br /> Plans Approved . ... .. e <br /> NOTE: A preliminary site inspection must be made and site approval granted on all struc- � 9j <br /> tures involving sanitary facilities before construction can begin. In the case of sewerage dis- <br /> posal systems, a copy of the percolation test in oat be attached to this application before a i <br /> permit will be issued. Do not purchase or,install a septic tank, do any plumbing or start any O <br /> building until a permit has been issued. A'permit may be revoked if misrepresentation of n <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 />