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... a , eit_comp <br /> . . <br /> G y - - <br /> 03 Burnett County Office of Zoning Administrator S' g • x <br /> o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT "' �Q <br /> To the Zoning Administrator: The undersigned hereby makes application for 4 <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, `� p <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- It <br /> lations of the State of Wisconsin. • 0 <br /> x -- .,�:.P-4/ Q..w., c (O 391. .Old .ate �' <br /> Owner or A nt lease rint Contractor or Survey <br /> o <br /> (P P ) Y <br /> ,7 . t `N <br /> Address Address <br /> v <br /> N <br /> Phone Phone 'gyp <br /> dI <br /> Plumber Well Driller cg i:I \ <br /> (---Y- thi-Try (A cabe.„44.4-z, . <br /> Address , Address <br /> .----\:S;("1",-1,-,- Q7,...-ics '-' 5' <br /> al <br /> Phone 7H--� 6 Phone <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities y . CA <br /> 1. Work (check one) Type oConstruction <br /> ns ction No. Bathrooms _I 2 r �j <br /> New Building Dishwasher <br /> Garbage Grinder Z <br /> Addition Size .`-. . ft. x S._G., ft. Autom. Laundry ) . <br /> Sanitary . . ... No. Bedrooms . <br /> Alterations Height ... . Stories . ... Waste Disposal : <br /> Moving Area System <br /> Wrecking Septic Tank Size/y66 <br /> Mobile Home 5. Permits Required <br /> Gallons C. oo' 6. .4- <br /> Privy Subdivision _ • <br /> ' 06 <br /> Well Sanitary Absorption Field Site g, <br /> Subdivision Building V Soil Type c <br /> Slope o `i <br /> Well Pere. Rate �' V" <br /> 2. Classification Other (Specify) Dry Well ;—7$.5 ( UJ <br /> Zoning Dist. Coonnditional Seepage Trench <br /> Land Privy <br /> 3. Lot Size 6. Use (describe exactly, 1- Seepage Bed c� a <br /> fam. home, motel, etc.) FOR COMMERCIAL USE �y <br /> ft. x ft. 1.� <br /> Plans Submitted �r <br /> /.5.,7. . . -ft:- ' Plans Approved cs." <br /> 'd <br /> cZc.. 1, <br /> '.NOTE: A preliminary site inspection must be made and site approval granted on all struc- v1 <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 <br /> permit will be issued. Do not purchase or ins tall a septic tank, do any plumbing or start any , <br /> ea <br /> building until a permit has been issued. A permit may be revoked if misrepresentation of co <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 n <br /> SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. : <br />