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e. <br /> k 4. Of i Ctolp f 0....--- <br /> • d 0-3 <br /> o o <br /> Burnett County Office of Zoning Administrator g' <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 2.' <br /> To the Zoning Administrator: The undersigned hereby makes application for V; , <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 <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- N.. p <br /> lations of the S to of Wisconsin. rfp, <br /> .05Vi.. . .. �:v Q t. ): :. . <br /> Owner or Agent (plea eprmt) Contractor Surveyor <br /> 1.?f.f... _ <br /> Address 1) 4J Address <br /> '�-1...7.4. Ii Phone <br /> Pone <br /> Plumber Well Driller e <br /> g <br /> Address Address <br /> Phone Phone `) " <br /> eg <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities <br /> Type of Construction No. Bathrooms <br /> 1. Work (check one) ,, ''' b - <br /> •fj ,tom,,�r r e,c, " Dishwasher .+ <br /> New Building Garbage Grinder <br /> Addition Size ft. x ft. Autom. Laundry <br /> 0� <br /> Sanitary 4 No. Bedrooms .!):. (•-s :P <br /> Alterations Height ... . Stories .... Waste Disposal i-(1 <br /> 4 <br /> Moving Area System A <br /> Wrecking Septic Tank Size P. <br /> Mobile Home 5. Permits Required f c c;,,, Gallons °' — <br /> Privy Subdivision Absorption Field Si a' fe <br /> Well Sanitary Soil Type C`-"` Q i <br /> Subdivision Building Slope wi ° I °3 <br /> Other (Specify)Well Pere. Rate c`"'`i2 , d <br /> 2. Classification p y) Dry Well .)-.) <br /> Zoning Dist. Coondditional Seepage Trench #s' • 0 <br /> L <br /> Privy <br /> 3. Lot Size 6. Use (describe exactly, 1- Seepage Bed I.P,J(41 4"-..z. c <br /> fam. home, motel, etc.) FOR COMMERCIAL USE 1 <br /> ft. x ft. Plans Submitted <br /> jj <br /> sq. ft. ) �`,, Plans Approved 'd <br /> • <br /> NOTE: A preliminary site inspection must be made and site approval granted on all struc- .0 <br /> tures involving sanitary facilities before construction can begin. In the case of sewerage dis- r <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 as <br /> building until a permit has been issued. A permit may be revoked if misrepresentation of A <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 •1/1 <br /> SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. : 1 <br />