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0 <br /> Burnett County Office of Zoning Administrator <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <br /> To the Zoning Administrator: The undersigned hereby makes application for :C Q <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, rs p <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- <br /> lations of the State of Wisconsin. <br /> . . .. . A . I.�1.4�.7 .. ... /l!i c k1 er. <br /> T�.. . .. .. • • ...... <br /> .. .. <br /> OwnerQ'.Q or Agent�d...(please print)VContractor or Surveyor <br /> 4l.d. .1....!�t.. .. .1�. �. ..?.......... .... ...... .... .. .......... ................ °f <br /> s <br /> Address t- Address o <br /> ih !.• S, S .. `..I ............ .... ... . ..... . . <br /> Phone Phone <br /> f ... .... ......... ... .. .. ... . .... .......... ...... .. • . .. .. .. . _ <br /> Plumber Well Driller <br /> Address. ......... .. . .. .. .... ... .......... Addreas..... .... . ... ........... . . .. ....... S �. <br /> S �A <br /> Phone .• ............................. .... Phone .... .. . ......... .. ......... ......... �1 <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities ) S <br /> 1. Work (check one) Type of Construction No. Bathrooms <br /> New B `/ �r 4 rYn Dishwasher . . • .. • » <br /> AdditionGarbage Grinder <br /> :: Size .a� ft. x � ft. Autom. Laundry 4 <br /> Sanitary No. Bedrooms <br /> Alterations ...... Height .... Stories .... Waste Disposal G <br /> Moving ...... AreaSystem .. . . • . <br /> Wrecking ...... Septic Tank Size r <br /> Mobile Home ...... 5. Permits Required O c?• ••• Gallons + <br /> Privy Subdivision Absorption Field Site <br /> Well !/•• Sanitary L� Soil Type .,1:Qhl �pp yg <br /> Subdivision ... ... Building r Slope <br /> Well -•4._� Perc. Rate . .. .. .. . • • .. <br /> Other (Specify) <br /> 2. Classification ••••• • Dry Well . .. .. . - <br /> Zoning Dist. ...... Conditional ... . ..ditional Seepage Trench . .. ... <br /> Pri"y <br /> 3. Lot Size 8. Use describe exactly, 1- Seepage Bed :� c <br /> X a home otel, etc.) FOR COMMERCIAL USE <br /> Plans Submitted <br /> �.4..fisq. ft. Plans Approved ...... N <br /> NOTE: A preliminary site inspection must be made and site approval granted on all struc- 3 <br /> tures involving sanitary facilities before construction can begin. In the case of sewerage dis• A <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 m <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. ; ;�3 <br />