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e y z <br /> Burnett County Office of Zoning Administrator r <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, p <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- <br /> lations of the State of Wisconsin. ti <br /> a.�k .. .. . .. ... . .. .. .. .. ... . .. .. .. .... ... .. . ... . ... <br /> Owner Agent (please print) Contractor or Surveyor <br /> /J �.�. .... /St.. . ... .. .... <br /> Address Address <br /> PhonePhone...*n'e' .. .... .... ... . .... .. .... .. ... ... . <br /> tv <br /> 19Q.ll... GLf7./.G'�5.. .. .. .. ..... .. .. ....... . .. .. .. .. .. ... . .. .. . . .. . . . <br /> Plumber Well Driller A <br /> Address Address <br /> g <br /> . ... ...... 7r <br /> Phone Phone ,� <br /> DESCRIPTION 4. Building Details 7. Sanitary Facihties <br /> 1. Work (check one) Type of Construction No. Bathrooms <br /> New Building Dishwasher ... .. . <br /> Addition Garbage Grinder <br /> Sift <br /> Sanitary Size . . . .. . x .. .. . ft. Autom. Laundry <br /> No. Bedrooms <br /> Alterations ...... Height . .. . Stories . ... Waste Disposal <br /> Moving .... System <br /> Wrecking �\ <br /> Area ... .. . .. y <br /> B •••••• Septic Tank Size � <br /> MobilPrivye Home . .. ... 5. Permits Required �7� Gallons m <br /> Well : : Subdivision Absorption Field Site <br /> Sanitary Soil Type <br /> r <br /> Subdivision . • • .. . BuildingSlope <br /> ; <br /> Well x , Pere. Rate . .. � . . d <br /> 2. Classification Other (Specify) ... .. . Dry Well <br /> g Conditional Seepage Trench <br /> Zoning Dist. . . . <br /> Land Privy Pn /��'8 <br /> 3. Lot Size 6. Use (describe exactly, 1- Seepage Bed ayrSG c <br /> fam. home, motel, etc.) FOR COMMERCIAL USE <br /> ft. x .... ... ft. Plans Submitted . ..... L <br /> ti <br /> . .. . . .. . .. . .. . ... sq. ft. /7 Plans Approved .. . .. . n��yw <br /> NOTE: A preliminarysite 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 o <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 />