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do <br /> Burnett County Office of Zoning Administrator S. P 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <br /> To tiw Zoning Administrator: The undersigned hereby makes application for t •C4 :O <br /> a Permit for the work described and located as shown herein. The undersigned agrees that o <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- II E <br /> latio of the State of Wisconsin. <br /> :O <br /> OfWol ent (please print) Contractor or Surveyor ; o�•p U <br /> . ....wU s�...,s'�l.P.f. }...... .... ................. ..... <br /> Address Address <br /> ......... .... .... .. . . .... ... . .. . . .. .... .. ....... .. .... ............ .... .. .. .. ... ... . <br /> Phon Phone <br /> d <br /> Plu ber Well Driller 4' S <br /> Address Address <br /> . ... . . ...... ... <br /> Phone Phone � ' <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities / : <br /> 1. Work (check one) Type of Construction' J� No. Bathrooms . .1. . . <br /> New Building I �4.!y"`e yd• Dishwasher . . ... . <br /> Addition �� Garbage Grinder .... + <br /> Size f. ,U, , ft. x .1 ft. Autom. Laundry <br /> Sanitary <br /> Alterations Height Stories .,,, No. Bedrooms <br /> Waste Disposal 1^ <br /> Moving System 3 <br /> F <br /> Wrecking ...... Area ... .. .. . ... . Septic Tank Size y o <br /> Mobile Home 5. Permits Required til m <br /> Privy • •• • Subdivision 1 S ... . .... G ons 9: <br /> Well Absorption Field Site <br /> .. .. . _l <br /> Sanitary L! Soil Type . 4!1..9. .. <br /> Subdivision Building <br /> Slope . .. . . <br /> Well .. .. . . ..:PereRate <br /> . . <br /> ° <br /> Dry 'wen :W2. Classification Other (Specify) . .... . . 4-N <br /> Zoning Dist. ...... Conditional Seepage Trench <br /> Land . . . .. . Privy . . . <br /> 3. Lot Size 6. U be exactly, 1- Seepage Bed . .. . y _� <br /> O <br /> //'' fam. home, otel, etc.) FOR COMMERCIAL USE <br /> x .Z.Q V ft. �. <br /> Plans Submitted . ..... I <br /> . .. .. . ... . ... .. . . sq. ft. Plans Approved ... ... C o <br /> NOTE: A preliminary site inspection must be made and site approval granted on all c- r :p <br /> tures involving sanitary facilities before construction can begin. In the case of sewers dis- <br /> posal systems, a copy of the percolation test must be attached to this application be re a <br /> permit will be issued. Do not purchase or install a septic tank, do any plumbing or s6ut any :[N <br /> building until a permit has been issued. A permit may be revoked if misrepresentation of A r <br /> any of the information conveyed herewith is found to exist. Changes in plans or specifics- <br /> tions <br /> pe ' cs- :\ n <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 />