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IN <br /> t7 H z <br /> Burnett County Office of Zoning Administrator r' - <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT :A <br /> M . <br /> To the Zoning Administrator; The undersigned hereby makes application for { G <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, 'l .�•' p <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- <br /> lations of the State of Wisconsin. <br /> ... .... .... ... . .... .... .... .... ... ..... ... <br /> Owner or-Agent(please print) Contractor or Surveyor <br /> .:............... <br /> Address Address .' <br /> .... ... . .......... .. .... r. <br /> Phone Phone <br /> :..SS'r54......... .... .. ... . . ...4 .. ......... .... .... .. . ....... .. .. . .. <br /> Plumber Well Driller <br /> c� :C— <br /> Address5 -w,..\.,��. �.... ..... .. .. ...... Address... ... .... . ........ .... . .. ........ ._ <br /> s J <br /> SL.{...... ......... .. .. .... ...... .... .... .... ... ..... ..... .. .... ..... <br /> Phone Phone <br /> DESCRUMON 4, Building Details 7. Sanitary Facilities <br /> 1. Work (check one) Type of Construction No. Bathrooms ... .I' <br /> New Building <br /> Dishwasher .. <br /> .. .. •.r:✓.54...•e ••••. Garbage Grinder .. . <br /> Addition • ••••• Size 4-.. ft, x �, ft. Autom. Laundry . J.C.. •'c <br /> Sanitary . ...C.. - , <br /> Alterations ...... Height .I}� Stories .�., No. Bedrooms ..-�... :W ;.(] <br /> Movie ,•,,,• i� Waste Disposal ; <br /> Moving Area ..L`.t4.V.....$.�. . System ... .. . ') <br /> Wrecking ...... Septic Tank Size <br /> Mobile Home ...... 5. Permits Required q Z <br /> PrivySubdivision . .. ..... .. ... Gallons <br /> .... . <br /> Well ••'. Sanitary .. Absorption Field Site <br /> . <br /> Soo) Type ... ... ....... y, <br /> Subdivision ... ... Building �.'•l. � Slope � "T� L o <br /> ? e <br /> 2. Classification Other (Specify)well X„ Pere. Ra• o <br /> te .7., .. ... .. {' 'N <br /> ... Dry Well .. . ... :n :-.1 <br /> Zoning Dist. ..... . additional .. ... . <br /> Seepage Trench <br /> La ... ... Privy . . <br /> 3. Let Size 6. Use (describe exactly, L• Seepage Bed .. .: <br /> _ �. •� <br /> fam. home, motel, etc,) _y ft. x .�'j'L ft. COMMERCIAL USE ( <br /> 7-5'a. ... . sq. ft. Plans Approved ... ... b:G V tr. <br /> i N) <br /> NOTE: A preliminary site inspection must be made and site approval granted on all struc- <br /> :•7 <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 he attached to this application before a <br /> permit will be issued. Do not purchase or install a septic lank, do any plumbing or start any <br /> building until a permit has been issued. A permit may be revoked if misrepresentation of :F � � , <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 :� :E- <br /> SHALL <br /> GSHALT. NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br /> s: <br /> 7 • <br />