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' <br /> Burnett County - Office of Zoning Administrator 0 O :0W R og :W <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT " <br /> O <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 :J� <br /> all work shall be done in accordance with the requirements of the County Zoning Ordinance, : 1 .r o <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- :--.f e <br /> lations of the State of Wisconsin. •i9, <br /> n : m <br /> w�srA�. ..�r . ..... .....:... . .. .............. .... . ... ..... ......... ... <br /> Owner or Agent (please print' Contractor or Surveyor <br /> C <br /> Address S5-oy y Address �l <br /> ... .......... <br /> Phone Pho... . ...ne.............. .. <br /> .. ........ . ....... .... . <br /> ......... ... . ... .... .... . . ... e <br /> Plumber Well Driller <br /> r <br /> J.�174.�.N.... . ...... .... ...... o S _ <br /> ...... ...... ............ ......... ..... S <br /> Address Address - ' <br /> (sd . <br /> ........ .... ............................. .......... .... ...... .... .... ......... ..... <br /> Phone Plione � <br /> hu\ <br /> DESCRIPTION 9. Building Details 7. Sanitary Facilities <br /> 1. Work (check one) Type of Cos yctionNo. Bathrooms ...... <br /> New Building � � � (' /!K.' / Dishwasher ... . C31 <br /> _�,{-,Q),(', x 1 Parc 1 Garbage Grinder ..... . { :N <br /> Addition •• Size rr2a ft. ft. Autom. Laundry <br /> Sanitary . .x.. - No. Bedrooms <br /> Alterations ... ... Height .... Stories .... ;1 ;W <br /> Waste Disposal , <br /> Moving ...... Area System ......i:' <br /> Wrecking ...... ... ...:.... Septic Tank Size . <br /> Mobile Home . ...... '5. Permits Required 'a' <br /> Privy Subdivision 7.d Gallons .2 m <br /> Absorption Field Site <br /> Well ... Sanitary SoilBuilding "-? 1 ` <br /> Subdivision ... ... Type . S . ...... . <br /> �•!S� � Slope ........ <br /> well K Perc. Rate C Ly#. .q:-.. . p <br /> 2. Classification Other (Specify) ...... Dry Well ' .. . ... <br /> Zoning Dist. ...... Conditional . .... . Seepage Trench ... ... :(T, <br /> Land <br /> 3. Lot Size 6. U "ribe exactly, I- Seepage Bed 1.1 A4 3. , 2 o .� <br /> /r?Q �2 fam. he e, motel, etc.) FOR COMMERCIAL USE <br /> 4 ft. x :. ....t.� <br /> Plans Submitted ..... . <br /> . ............ .... sq. ft. Plans Approved . .... . ,J1 'o <br /> NOTE: A preliminary site inspection must be made and site approval granted on all struc- <br /> :() <br /> tures involving sanitary facilities before construction can begin. In the case of sewerage dis- ilk <br /> posal systems, a copy of the percolation test must be attached to this application before a - U <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 n <br /> any of the information conveyed herewith is found to exist. Changes in plans or specifica- <br /> tions shall not he made without approval of the Zoning Administrator. SEWER SYSTEM <br /> SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />