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d y 2 <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 .f L <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- <br /> lations of the State of Wisconsin. ;LN •�^ ;; <br /> .......... . .. .. .. ...... . . .. .. .. . ... .... . . . . .. .. ..... <br /> s 1 <br /> Owner or Agent (please print) Contractor or Surveyor <br /> Addre�....cii ....!......Y .h... . �no�o -dr <br /> . .. ....... ......................... <br /> _ V, <br /> .5-.3 �4 <br /> Phone Phone <br /> . . �.��.s......... .. .. . . d <br /> Plumber Well Driller r� <br /> io <br /> ... . .. . . .. .. ......... . . . . .. .. .. . �► :n <br /> Address... .. .. .... .. .. ............. .. .... Addres .. <br /> s S, :S <br /> Phone ........ ...... .. .. ........... .. .... Phone . . .. .. .. .. . . .. .. .. .. .. ..... .... .. .. . <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities y <br /> 1. Work (check one) Type of Construction No. Bathrooms .. . <br /> New Building JAi!i�. . 4.�2�.4nco'c.LDishwasher . . . .. . <br /> Addition Size' ��. ft. x 3 G ff>�►seM� geron <br /> ulnndry r <br /> Y... <br /> Sanitary No. Bedrooms <br /> Alterations ...... Height .. .. Stories .... Waste Disposal :C <br /> Moving ...... Area System . .. .. . <br /> Wrecking ...... . .. ........ .. . ... . Septic Tank Size <br /> Mobile Home 5. Permits Required . ..F . . Co <br /> A <br /> Privy y Subdivision ••• Gallons <br /> 1�. . Absorption Fi ld Site <br /> Well <br /> Sanitary ✓ Soil Type <br /> Subdivision ...... Building SlopeWell <br /> Perc. Rate <br /> Other <br /> 2. Classification (Specify) Dry Well . .. .. . <br /> Zoning Dist. ...... Conditional •••• • Seepage Trench . .... . <br /> Land ... .1. ; I <br /> Privy <br /> 3. Lot Size 6. Use (describe exactly I. ' Seepage Bed <br /> x /fam. home,jmotel, etc. _ FOR COMMERCIAL USE 4' <br /> • ••'' • —� Plans Submitted <br /> sq. ft. Plans Approved i <br /> NOTE: A preliminary site inspection must be made and site approval <br /> p ary pe pp 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 /> 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 THUS OFFICE AND APPROVED. ti <br />