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d H Z <br /> Burnett County Office of Zoning Administrator <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <br /> To this 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, :t <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- <br /> lations <br /> egu• <br /> latio�f the State oLNisconsin.. ... .. ...... . � <br /> Owner or Ag (please print) Contractor or Surveyor <br /> .�t.:I.4J.ir.i: r.rAV.Ct................... . <br /> Address r/ Address <br /> Phon ........ .... .. ..... . .... ...... .. .. .. Phone ......... ....... ......... ...... .... . I <br /> CJ.�`. �).l.r?.5.. d bn <br /> P u ber Well Driller <br /> Address. .. .. .. .... .. .. .. .. ..... ....... Address <br /> .. .. .. .. ........ . . .... .......I . .. . . .. .... . :7 <br /> . <br /> .•. <br /> . ...... <br /> Phone .. ...... .. ....::. ^ . Phone .. .. .. .. .. . . .. .. .. .. ....... .... ... . . � . <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities <br /> 1. Work (check one) / Type of Construction No. Bathrooms <br /> Dishwasher . . . .. . <br /> New Buildingf/ <br /> _y Garbage Grinder .... <br /> Addition Size a ft. x ? ft. Autom. Laundry <br /> Sanitary No. Bedrooms <br /> Alterations ...... Height . .. . Stories . ... <br /> Waste Disposal <br /> Moving ..... . Area System r' <br /> Wrecking ...... Septic Tank Size <br /> Mobile Home . ..... 5. Permits Required F,, �, <br /> Privy ..... . Subdivision Absorption r Gall�onJs <br /> Well Ll Sanitary `".: S it Type 00�?. `�• <br /> Subdivision •••••• Building Slope . . . °d <br /> Well Perc. Rate <br /> 2. Classification Other (Specify) ,.. .. . Dry Well Q <br /> Zoning Dist. ...... Conditional •• ••. • Seepage Trench . .. .. . W <br /> Land ... .. . Privy <br /> c <br /> 3. Lot Size 6. U be exactly, 1- Seepage Bed �.0�,�Co1S : o <br /> fam. home, motel, etc.) FOR COMMERCIAL USE u <br /> ft. x .. ..... ft. <br /> Plans Submitted . . Q <br /> eq. ft. Plans Approved . .. .. . C <br /> r <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 /> 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 />