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� I <br /> � O O <br /> Burnett County Office of Zoning Administrator <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <br /> To the Zoning Administrator: The undersigned hereby makes application for 1 (;^ <br /> a Permit for the work described and located as shown herein. The undersigned agrees that f J <br /> all work shall be done in accordance with the requirements of the County Zoning Ordinance, ' <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- <br /> lations of the State of Wisconsin. :N <br /> 0 <br /> .... . ... ...... �� 1 .. .. .. .. . . . . .. .. ... ti! : d <br /> Owner or Agent (plea/se print) Contractor or Surveyor <br /> Pt,SC. ... . . . .. . .. .... ........ ... .... .... .. . <br /> Address Address : ;5 <br /> :7.!,f"-. 9. ....... .... ..... . .. .. .. .. . . <br /> Phone Phone <br /> ......... . . . . .. .. . . <br /> Plumber Well Driller A <br /> A e•► <br /> aaaTess. .. .. .. .... . . . . .... .. ... .... .. .. .. � <br /> . . . ... . . ... . . .. .... .. ... .. .. .... .. . <br /> A"daies s <br /> Phone Phoney° <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities <br /> 1. Work (check one) / Type of Construction No. Bathrooms <br /> New Building �✓, ! 9`"^'?... .. .. .. Dishwasher ' �* <br /> Garbage Grinder <br /> �f . .. ... <br /> Addition . ' <br /> Size .�, ft. x .s�? ft. Autom. Laundry ,,rr11 .; <br /> Sanitary No. Bedrooms <br /> Alterations ...... Height . .. . Stories . ..• Waste Disposal <br /> Moving ••• ••• Area System <br /> Wrecking ...... Septic Tank Size <br /> Mobile Home . ..... 5. Permits Required Sanitary Soil <br /> Field Site <br /> Type <br /> Gallons W <br /> � <br /> Privy ••� Subdivision . .... . •• <br /> Well �f � <br /> J n !z <br /> Subdivision . .. .. . j . 5 <br /> Building . .�� Slope . .. . . .. .. .... .. . O• o� <br /> Well Pere. Rate . .. . . . . . . .. . <br /> 2. Classification Other (Specify) . .. . . . Dry Well . .. . . . 4N A' <br /> Zoning Dist. ...... Conditional • •• •• • Seepage Trench <br /> Land . .. . . . Privy <br /> 3. Lot S' 6. Abe exactly, 1- Seepage Bed <br /> Q� fam. hom , motel, etc.) FOR COMMERCIAL USE <br /> x Plans ans Submitted . . . ... <br /> y� �. .. .. .. .. . . .. . . . . sq. ft. Plans Approved . ..... I 'd <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 _. d <br /> permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any ; <br /> building until a permit has been issued. A permit may be revoked if misrepresentation of <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 />