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.... ",,, <br /> d si o O <br /> Burnett County Office of Zoning Administrator 6. <br /> M <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT Q <br /> To the Zoning Administrator: The undersigned hereby makes application for .,I•-- <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, p <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- a <br /> lations of the State of Wisconsin. I L <br /> SeIP <br /> Owner or Agent (please print) Contractor or Surveyor t ��- <br /> Address J /I ern; e, MN 55096 Address ' (� <br /> Phone Phone <br /> EdWa r d .i 4) Ier i' i' kh <br /> Plumber Well Driller <br /> Address Address <br /> Phone Phone pg .1‘+ <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities / <br /> Type of C struction No. Bathrooms <br /> 1. Work (check one) v r � Y? b •Dishwasher �* <br /> New Building G Garbage Grinder . Z Z <br /> Addition Size O x ,fit' AA Autom. Laundry es f� �, <br /> Sanitary it X lkj fit/ .f, 4.1- - ,No. Bedrooms ( \`� <br /> Alterations Height .. . . Stories . ... Waste Disposal <br /> Moving Area System <br /> Wrecking Septic Tank Size <br /> Mobile Home 5. Permits Required <br /> t?�-ll..!_ Gallons v' <br /> Privy Subdivision ✓ Absorption Field Site <br /> Well •£• Sanitary 1 Soil Type :-Z ,r)c <br /> Subdivision Building Slope •` C! <br /> Well Perc. Rate p 3 :% <br /> 2. Classification Other (Specify) Dry Well ` <br /> Zoning Dist. Conditional Seepage Trench 4.1',t.12 <br /> Land Privy /, L.' -4 <br /> 3. Lo Size 6. Use (deacribe exactly Seepage Bed c,1-`7" I oZ 4 a -11 <br /> �) fam. home,(motel, etc.) FOR COMMERCIAL USE `J <br /> ft. x v ft. J Plans Submitted ( no r. <br /> sq. ft. Plans Approved —7-1'0 <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 V ' <br /> permit will be issued. Do not purchase or ins tall a septic tank, do any plumbing or start any <br /> as (3 <br /> building until a permit has been issued. A permit may be revoked if misrepresentation of CD <br /> any of the information conveyed herewith is found to exist. Changes in plans or specifica- • (J <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 />