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oti coIy p <br /> V ' <br /> O p <br /> Burnett County Office of Zoning Administrator 6' <br /> o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT "' <br /> To the Zoning Administrator: The undersigned hereby makes application for ' t 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, �'� o 0 <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- <br /> lation f the State of Wisconsin. ,,1 <br /> irs, <br /> Owner or Agent (please print) Contractor or Surveyor Nio v <br /> /( d SPo n..4)v- (hrrse . <br /> Address Address T <br /> Phone ' Phone <br /> ./.l Hoiati,y d <br /> (i <br /> Plumber Well Driller A <br /> 0. I . <br /> g <br /> Address Address i/ <br /> T 0 <br /> Phone Phone roi/-7; <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities <br /> 1. Work (check one) Type of Cons ction No. Bathrooms r <br /> Dishwasher r► <br /> New Building ..U.. 'd '' Garbage Grinder ,j . +C <br /> Addition f�/ Size ft. x ft. Autom. Laundry !x. <br /> Sanitary No. Bedrooms /120/1J <br /> Alterations Height ... . Stories .... <br /> Waste Disposal <br /> Moving Area System C\ <br /> Wrecking Septic Tank Size <br /> Mobile Home 5. Permits Required <br /> Privy Subdivision .` 0. . ... GallonsC..., ri' <br /> Well Sanitary Absorption <br /> Type Field'itesf. .. . Q 1 <br /> Subdivision Building Slope ,r- o <br /> Well <br /> Pere. Rate lo • <br /> 2. Classification (Specify)y) Dry Well <br /> .* ..), ---q <br /> Zoning Dist. Conditional Seepage Trench ;---. <br /> Land Privy - <br /> 6. U escribe exactly, 1- Seepage Bed IdX1J 1-33. Lot Size Y, <br /> fames motel, etc.) FOR COMMERCIAL USE N <br /> ft. x ft. Plans Submitted E. <br /> 43 sq. ft. Plans Approved -4.,, b <br /> o <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 g <br /> permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any <br /> Go <br /> building until a permit has been issued. A permit may be revoked if misrepresentation of 0 ' <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 /> IN <br /> SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />