Laserfiche WebLink
• Number <br /> APPLICATION FOR BUILDING & SANITARY PEIIJAIT <br /> urnett County, sconsin <br /> Dately_o��— �G <br /> Name Addteee <br /> Phone # <br /> DESCRIPTION: Gov't . Lot # <br /> of a of Sec . _, T l N, F. /{ �0, Town <br /> Lot # b Subdivision Lott ize� <br /> Contractor: <br /> ;z <br /> [ ] Building Construction - # fiedrooms <br /> ( ) New USE ` <br /> AdditionF p±ily twelling <br /> ( ) Moved Commeial <br /> ( ) Other ` ( ) Others <br /> ,. , <br /> [ ] Sewage Disposal Vnit <br /> ( !4 Septicnuc { f' y X11 )A Seepage Bed <br /> ( ) Seepageench ) Other <br /> 9 <br /> [ ] Well ( 1:kriven,. ( ¢ ) P.ril;kd Planned Depth <br /> ? i F <br /> CFRTIrICATE << <br /> I , the u an d, 2 `heb 16 ti4that :the above statements and any <br /> att ed i a"ti n a t and connect to .the best oA my hnowted9e . <br /> App t Address !r�,c�6�L/�,_ i <br /> Permit Rec pt Permit <br /> Issued �O r #_� �_ Denied <br /> ll e 41. Date <br /> Reason for denial <br /> Signed <br /> k Zo ing Adminis ator <br /> Certificate of Compliance Psued - Date <br /> Septic Tank Permit # _S124 _ Date -v2q-70 <br /> NOTE: <br /> Submit completed application and $6 . 00 fee to: Truman Smith, <br /> Burnett County Zoning Administrator, Box 117, Webster, Wis . 54393 . <br /> In the case of sewerage disposal systems , a copy of the percolation <br /> test must be attached to this application before a permit will be <br /> issued . Do not nurchase or install a septic tank, do any plumb'-ng <br /> or start any building until a permit has been issued. A permit may <br /> be revoked if misrepresentation of any of the information conveyed. <br /> herewith is found to exist . Changes in plans or specifications shall <br /> not be made without approval of the Zoning Administrator. <br />