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O. O <br /> � Burnett County Office of Zoning Administrator S � <br /> C APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT � <br /> To the Zoning Administrator: The undersigned hereby makes application for <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 <br /> Sanitation Code, and with ell other applicable County Ordinances and the laws and regu- " o <br /> lotions of the State of Wisconsin. /�— < I <br /> t.r{.e.Yt.. ....cJ.Q.� n.r.G> .d. . ..�b.��.! ).1.. .�. 1. .4..4..Y.✓.... . <br /> Owner or Agent ease print) optractor or Sur"veyor <br /> ni <br /> Address .. Address ; <br /> a � ... .�.K. .c.d.. ....�'� <br /> Phone ... Phone <br /> tv <br /> .. .. ... . . . ..... . .... .. . i <br /> ... qqq � <br /> Plu bar Well Driller �� II 2 r <br /> .... .. ........ . ...,.... �.. <br /> Address Addreat <br /> ... ... .... .... ........ ....... ............ . .... .... . .. ........ .... .... ..... .... ... . . S ;� <br /> Phone Phone <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities . <br /> -L-Work (check one) Type of Construction No. Bathrooms <br /> ��! •, f,Q,�„� .__,. Dishwasher <br /> New Building . .... . <br /> Addition Garbage Grinder I <br /> Sanitary Size 3;.a. ftvxp. ft. Autom. Laundry �t <br /> Alterations .. Height .... ..' StorPes.... �O No. aDisposal Bedrooms <br /> Waste Disposal -. <br /> Moving ... ... Area System . .. ... <br /> Wrecking - ...... .. .... .... .... . Septic Tank Size <br /> Mobile Home . .... . 5. Permits Required <br /> Privy / Subdivisionl� Absorption Field Site <br /> Gallons <br /> �.0 � I( <br /> Well % - Sanitary { <br /> Soil Type -. ... .... '� <br /> Subdivision ... ... Building Slope <br /> Rate <br /> ....... . . o I <br /> Well . .. ..� - Pere. Aate .... .... ... <br /> 2. Classification Other (Specify) ...... Dty. Well . .... . d �I <br /> yog{gg Dist. �_--;� Conditional ...... Seepage Trench I ��� j <br /> Land . .. . .. wry, ....... Q. <br /> 3. Lot Size 6. Use-(describe exactly, 1- Seepage Bed :� c <br /> A�. . ft. x .7.m. re. <br /> tam. home; motel, etc.) FOR COMMERCIAL USE :V :sem e <br /> Plans Submitted ... ... ;�- M <br /> . ... . ............ sq. ft.. Plans Approved ... ... <br /> O <br /> NOTE: A preliminary site inspection must be made and site approval granted on all struc- <br /> lures 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 <br /> permit will be issued, Do not purchase or install a septic tank, do any plumbing or start any wC <br /> building until a permit has been issued. A permit may be revoked if misrepresentation of m -� <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 />