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tv y z <br /> Burnett County Office of Zoning Administrator k) <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMITM N <br /> : : U( <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 V) <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. <br /> ,G l�i a S � <br /> �...�. .. . . .......... .... . . . . . . . . . .. . .. .. .. . . . . . . . . . . .. . ;s <br /> Owner or (gent (please print) �/ Contractor orAu'rveyor <br /> rdt //,uc sm? Pj5. . .. .. .. .... .. .. . . .. .. .. ... .. .... .. . . . <br /> .� <br /> Address Io I6 Address <br /> �� -. �.- 9�/.. ...... .. .... . .. . . . . . . . . . <br /> ho5. <br /> Pne Phone o <br /> >°Y Su11 d :a <br /> Plumber Well Driller <br /> Address. . . . . .. .... .. . . . . . . . . ... .... ...... Address..... .. ... . .. ...... . . . . . . . . . . . . . .. . ,. <br /> g <br /> Phone Phone <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities <br /> 1. Work (check one) Type of Construction No. Bathrooms . . . <br /> c/ ��a �N e. . , . . , , Dishwasher . . . .. . '. <br /> New Building Garbage Grinder . . . .. . <br /> Addition /' ' <br /> Size c 4 ft. x .2 z. ft. Autom. Laundry <br /> Sanitary K.. <br /> Alterations . . . . Stories '� No. Bedrooms <br /> •,,: Height f.•. <br /> Waste Disposal <br /> Moving Area System . .. .. . <br /> Wrecking ...... Septic Tank Size <br /> Mobile Home ..... . 5. Permits Required Gallons <br /> PrivySubdivision : C <br /> Absorption Field Site u <br /> Well ..✓.. . SanitarySoil Type . . . . . . .. . . ... e o <br /> Subdivision Building <br /> Slope . . . . . . . . . .. . . ... v1 0' n <br /> Well <br /> Other (Specify) Pere. Rate . . . . . .. ..... es <br /> 2. Classification Y) Dry Well ..... . <br /> Zoning Dist. . .. ... Conditional • • • Seepage Trench <br /> Land ivy <br /> 3. Lot Size 6. U (describe exactly, l, Seepage Bed /y /s./ e <br /> fam. home, motel, etc. FOR COMMERCIAL USE : W <br /> . .. . . . . ft. x . . .. . . . ft. <br /> Plans Submitted <br /> IG.Q. 144 r�'S sq. ft. Plans Approved . . . .. . <br /> N% <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- :0 <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 p I <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 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 /> N <br /> Q <br />