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� O p <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 <br /> all work shall be done in accordance with the requirements of the County Zoning Ordinance, <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and <br /> regu- <br /> lations of the State of Wisconsin. <br /> ]n ., <br /> G' ^ t=....%hVS 7-V <br /> ..iv* .. <br /> Owner or Agent (please print) Contractor. .. ..... ..or. Surve..yor <br /> f� . .. .5�<.�� r�:�..... . �..... . ... ...... .. �:!? ....... ..... ...... <br /> Addressc Address <br /> . ... .. . .. ..q.....SIS. S <br /> Phone Phoneb , f <br /> N <br /> Plumber Well Driller <br /> Address Address � <br /> ... .. .. ........ ... .. ... <br /> Phone Phone <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities : g• <br /> 1. Work (check one) Type of Construction No. Bathrooms . ..4'. . <br /> �4.�,. Dishwasher . .. .. . ems,. .. '� <br /> New Building ..h. .• •• •• Garbage Grinder . .... . : : <br /> Addition � 5 r�fy't <br /> Sanitary . .. • Size .`f/r, ft, x J." ft. Autom. Laundry <br /> Alterations ...... Height . ... Stories . ... No. Bedrooms . .. ... <br /> Waste Disposal r\ <br /> Moving ... ... System <br /> Wrecking ...... Area . .. ...... .. .. .. .. . Septic Tank Size ; <br /> Mobile Home ..... . 5. Permits Required Gallons <br /> Privy •••• Subdivision <br /> Absorption Field Site <br /> Well -A"• Sanitary . .. .. . Soil Type � > <br /> . ...:!4?:: a <br /> Subdivision Building �.. Slope .... C AP..1` . .. . d <br /> Well .. . Pere. Rate . . . .. .. ... .. p <br /> 2. Classification Other (Specify) ..... . Dry Well ... .. . : t <br /> Zoning Dist. ...... Conditional • •• •• • Seepage Trench ... ... U, <br /> Land Privy C <br /> 3. Lot Size 6. Use (describe exactly, 1- Seepage Bed <br /> M _ l x fam. home, motel, etc.) FOR COMMERCIAL USE :l? <br /> Plans Submitted . ..... <br /> . .. . . .. .. . ... .... sq. ft. Plans Approved . ..... :� o <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 moat 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 m <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 v l <br /> SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. : <br />