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W�Burnett County Office of Zoning Administrator o.� <br /> o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT �4 <br /> "4 R <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, :3p p <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- � <br /> latii sgof the State of Wisconsin. <br /> . .. ... . .. .. . . .... .. . . .. .. .. . . . . . . . . . . .. . "o <br /> O gent (please print) Contra'c�t'or or Surveyor <br /> Address Address ;P <br /> ............. .. .. .. .. . . . ... ........ .. . . . ........ .. .. .. .. . . . ... ........ .. . . . . Phone ..... .. .. .. .. .. . . .... .. . . .. .. . . ... . . <br /> -4 L .. .......... .. .. . . .. . . d <br /> Plumber Well Driller :7Z) <br /> .J�l.�. . e.°.. .... ... .. .I .. .... ... .. .. .. .. .. . . .. .. .. .. .. . . . . . . . .. . . .. . :�o <br /> Address Address S <br /> .. . . .... .. ... . .... .... ... .. .. ...... Phone .. .. .. .. .. .. . . .. .. .... ... . . . ... .. . . . <br /> Phone d <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities <br /> 1. Work (check one) Type of Construction No. Bathrooms 1 <br /> �� �•� Dishwasher . . . .. . '* <br /> New Building ... ... Garbage Grinder . . <br /> Addition •�/ Size A N. ft. x ft. Autom. Laundry ' <br /> Sanitary Y No. Bedrooms •~ :� <br /> Alterations ... ... Height Stories .... Waste Disposal Z <br /> Moving ... ... Area ... . . ... . .... .. .. . System . .. . . . <br /> Wrecking ...... Septic Tank Size <br /> Mobile Home . ..... 5. Permits Required q Gallons./ti 0 ; <br /> Privy :•; � Subdivision • •••• • Absorption Field Site <br /> Well 1/ t✓' <br /> Subdivision Sanitary Soil Typ -J.a. n ram- S R <br /> Building �,/ Slope .�.°l o <br /> Well Pere. Rate . . . . . .. . . . . . is <br /> 2. Classification Other (Specify) . ..... Dry Well t i; <br /> Zoning Dist. ...... Cad onditional ... .. . Seepage Trench . .. <br /> L .. . <br /> Privy - <br /> 6. Us 'be exactly, 1- Seepage Bed !.a,X.a 0 :� y g <br /> 3. Lot Size Y ;T <br /> mom; motel, etc.) FOR COMMERCIAL USE <br /> ft. x .. ..... ft. u <br /> Plans Submitted <br /> sq. ft. Plans Approved . .. .. . 'o C <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 •� <br /> permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any :1* <br /> building until a permit has been issued. A permit may be revoked if misrepresentation of co <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 /> d <br />