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0 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 <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. <br /> Owner or Age t (please print) Contractor or Surveyor 9 6 <br /> �.r .<.�. . �.... . . ... .. .. . . . . .. . . .. . . . <br /> Adress Address <br /> Phone L Phone :�':b <br /> JIT'c?10./1 / -> S .... . ... .. .... .. . . .. . ... . . .. .. . . . . . <br /> Plu kr <br /> Well Driller <br /> ? . .$. � x . . .. . .. .. .. .... . . .... .. .... .. .. . . . . .. .. .... . . . .. . . .. .. .. . <br /> :r <br /> :3 <br /> Address Address ' <br /> .. <br /> .... . ... .. . .. <br /> :4 <br /> Phone Phone <br /> DESCRIPTION 4. BuildingDetails 7. Sanitary Facilities <br /> 1. Work (check one) Type of Construction No. Bathrooms <br /> F�•4 .�_ Dishwasher . .. .. . <br /> New Building v Garbage Grinder . .. .. . <br /> Addition Size ft. x ><'. ft. Autom. Laundry <br /> Sanitary No. Bedrooms <br /> Alterations ...... Height . .. . Stories . ... Waste Disposal Q <br /> Moving ... ... <br /> Area System f l XXJJ <br /> Wrecking ...... """ "" Septic Tank Size ; <br /> Mobile Home . .... . 5. Permits Required <br /> ./7.47_9. ... GallonsPrivy <br /> Well : :� Subdivision Absorption Field Site <br /> Subdivision Sanitary Soil Type .-T rf 4 d. .. . a <br /> Building L .�' Slope . . .�9. . o d <br /> Well Pere. Rate <br /> 2. Classification Other (Specify) .. . .. . Dry Well <br /> .... <br /> Zoning Diet. ConditionalLand . .. . . Seepage Trench . . . .. . � <br /> Privy <br /> 3. Lot Size 6. U ribe exactly, 1- Seepage Bed i x/.`� J c . <br /> ftx .. .. . ft. fam. home:motel, etc.) FOR COMMERCIAL USE C <br /> ... , .. Plans Submitted . .. .. . <br /> Plans Approved . .. .. . :fid <br /> :Qj <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- <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. <br />