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J <br /> d y z <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 <br /> a Permit for the work described and located as shown herein. The undersigned agrees that ; i p <br /> all work shall be done in accordance with the requirements of the County Zoning Ordinance, I✓ c <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- <br /> lations of the State of Wisconsin. ., <br /> � .P5 !'•:. �'�''!`�r'li � . . .. .. . . .. .. .. .. . . .. . . . . .. .. . . . . . . .. .... . �•••� <br /> Owner or A ent (please print) Contractor or Surveyor :�L :k <br /> 4 ` <br /> 13 9s .:. . .7.. .. .. .. ...r .. . . . .. . .. .. .. .. . . .... .. .. ...... ....... ...... . :r0 <br /> Address <br /> JrJ�' '. 1�?1�. .. . . .. .. ... . .. . . . .. . . . . . . . . . <br /> Phoneell <br /> Phone <br /> . . . . ` . ..�. .. . . . . .. . . . ..... . .. . . .. .. . . .... . . .. .. .. . . . d <br /> Xlumber Well Driller <br /> . ' � . ... .. .. .. .. .. . .. . .... .. .. .. .. .. .. .. .... ... .. .. .. .. .... . <br /> Address Address <br /> . .. . . . . . . . .. . . . . . .. .. .. ..... . .. ... . . . .Y <br /> Phone Phone x <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities <br /> 1. Work (check one) Type of Construction No. Bathrooms . .. . . . <br /> Dishwasher ... .. . �* <br /> New Building XGarbage Grinder <br /> Addition Size 1�ft. x�/�. ft. Autom. Laundry <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 C� � C4 <br /> Privy Gallons <br /> �'3' Subdivision & <br /> Well x . ": Absorption Field Site <br /> Sanitary Soil Type <br /> Subdivision Building . . Slope . . . . .-� . . ... . \' <br /> Well • • . Pere. Rate . . .. . <br /> 2. Classification Other (Specify) . .. . . . Dry Well N <br /> Zoning Dist. . .. ... Conditional • • . •. • Seepage Trench ..... . <br /> Land . .. . . . Privy o <br /> 3. Lot Size �, 6. Use (describe exactly, 1- Seepage Bed <br /> / fam. home, motel, etc.) FOR COMMERCIAL USE <br /> .�� . ft. xrA <br /> Plans Submitted �r <br /> . .. .. . . . . . ... .. .. sq. ft. Plans Approved . .. .. . <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 <br /> On <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 specifics- <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 />