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e y z <br /> Burnett County Office of Zoning Administrator 8- <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 regu- <br /> lations of the State of Wisconsin. ti <br /> t�IvL f rlEksow <br /> . .... .. . . .�. .. .... .. . . .. .:.. ... ... . . . .. . . .. . . .. .. . . .. . . .. .. . . .. . . . . . . . . .. . . . <br /> Owner or Agent (please print) ,�/ Contractor or Surveyor <br /> Crf�sstc>i-. . .rj. Al SSc��. . . . .. .. . . .. . .0.�3�� ���e l'� le.k �r <br /> Address f Address <br /> . ..Phone.... .. . . . .. . . .. .. .. <br /> . .. . <br /> . .. . . . . . . .. . ... . . <br /> Plumber .. .... .. . . .. . . ... . ... . . . .. . . . . . . WellDriller. . ... . . . .. . . .. . . ... . . . . . . . .. . . . �• <br /> .. .. . . .. .... . . . . .. . . . . . . .. .. ... . . . . .. .. .. . ... . <br /> Address / Address <br /> Phone Phone _ <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities .� <br /> 1. Work (check one) Type ��n� Dishwasher . . .. . . <br /> cting No. Bathrooms <br /> �TNew Building . ... .... .. . <br /> "' Garbage Grinder . .. . . . 011 <br /> Addition Size -2(t. ft. x .:j.�ft. Autom. Laundry :,4 <br /> Sanitary . .�. No. Bedrooms <br /> Alterations g I. <br /> Height Stories <br /> " ' Waste Disposal <br /> Moving .. . . :(VWreckin <br /> Area . .. . ... . . .. .. . . . . . System <br /> Wrecking • ••••• Septic Tank Size , <br /> Mobile Home . .... . 5. Permits Required <br /> Privy Subdivision • • • 7$®• • .• • Gallons -*41z,. c <br /> Well • Sanitary �C , Absorption Field Site <br /> Subdivision Soil Type . .,5. . <br /> Building . . , ro : <br /> Slope . .. . . .<�./ . . . . . ° <br /> Other (Specify)Well Perc. Rate . .. . . . ./.. . . . p <br /> 2. Classification 1` P y) •• • •• • Dry Well <br /> Zoning Dist. . .... . Conditional Seepage Trench . .... . <br /> Land . .. . . . <br /> Privy <br /> 3. Lot Size 6. Use (describe exactly, 1- Seepage Bed y <br /> x fam. home, motel, etc.) FOR COMMERCIAL USEft. q <br /> Plans Submitted . . . .. . <br /> . . . .. . . . . . . .. . . . . sq. ft. Plans Approved a <br /> .p <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 r' <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 ages in plans or specifics- 'L <br /> tions shall not be made without approval of the Zoning Administrator. SEWER SYSTEM . . • 1 <br /> SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br /> — M <br />