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d o p <br /> Burnett County Office of Zoning Administrator g' g <br /> °, -� <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT �„ ci <br /> To the Zoning Administrator: The undersigned hereby makes application for > i ,W` <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, '0 p <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- 4 c) p <br /> lations of the State of Wisconsin. . ji) ei; <br /> Owner or Agent (please print) Contractor or Surveyor <br /> ^- <br /> Address Address <br /> Phone Phone <br /> Plumber Well Driller e <br /> #4"-L 44 f- e '4 <br /> Address Address <br /> f0,56-— 37516 <br /> Phone Phone <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities <br /> 1. Work (check one) Type of Construction No. Bathrooms . .L.. v <br /> Dishwasher r. <br /> New Building Garbage Grinder <br /> Addition Size ft. x ft. Autom. Laundry . <br /> Sanitary No. Bedrooms . . <br /> Alterations Height ... . Stories .... Waste Disposal <br /> Moving Area System i <br /> Wrecking Septic Tank Size ,C <br /> Mobile Home 5. Permits Required / a o Gallons Ce <br /> Privy Subdivision ' <br /> Well SanitaryAbsorption Field Site <br /> Subdivision ' " ' ' Soil Type . 44" �?.<. Cr. <br /> Building Slope ® o' <br /> Well Perc. Rate 72 a 6 k 0 <br /> 2. Classification Other (Specify) Dry WellC. <br /> Zoning Dist. Land <br /> dditional Seepage Trench CI <br /> Privy <br /> 3. Lot Size 6. Use (describe exactly, 1- Seepage Bed Y c <br /> /37 GtC— fam. home, motel, etc.) FOR COMMERCIAL USE <br /> ft. x ft. ict-444..e3,/ 2 plans Submittedsq. ft. Plans Approved 'd <br /> Vu c <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 C- <br /> permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any OA <br /> building until a permit has been issued. A permit may be revoked if misrepresentation of eo <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 />