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0 0 0 <br /> Burnett County Office of Zoning Administrator to <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 Y ' <br /> all work shall be done in accordance with the requirements of the County Zoning Ordinance, u) 0 <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- <br /> lations of the State of Wisconsin. <br /> 14, <br /> Owner or Agent (please print) Contractor or Surveyor <br /> n1�.3 ,ML•�yKTI,�Iu.. G1i�Slv(1 MIHlq:. . .. ...... ... ..... ................ <br /> Addresses f Address <br /> ;T <br /> Phone <br /> ..... .... ...... ........ ...... . . .. .. .. . ... . A <br /> Phone <br /> {bJ�-N f+.,l. .. .. .... Well. .... .... .. .... .. ... ....... ...... .. .. .. . . . d c <br /> Plumber. Driller <br /> Ad4r�; �_. ... ..�/ !. 5. :.. . .. .. .. Address... ....... . .. ...... ... .. .... .. .. ... :C <br /> S b1 <br /> Phone Phone � f'S1 <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities <br /> 1. Work (check one) Type of Construction No. Bathrooms ...�.. �+ <br /> ���{�A f(�Gex{4 Dishwasher . ..... <br /> New Building <br /> Garbage Grinder . <br /> Addition Size . . ft. x ;;I".—ft. Autom. Laundry . '} <br /> Sanitary ••• •• No. Bedrooms <br /> Alterations Height Stories .... Waste DisposalV <br /> Moving ...... System �3 <br /> Wrecking ...... Area ..... .. ...... ..... Septic Tank Size <br /> Mobile Home . ..... 5. Permits Required <br /> Privy . ..... Subdivision . .. • ••Absorption Ftion Fiell Gallons <br /> � d Site <br /> Well . ..... Sanitary Soil <br /> Subdivision Type P ems' <br /> Building ... •. . Slope ...I-. . o o a <br /> Well Pere. Rate L ih55 l , • p <br /> 2. Classification 7 Other (Specify) ... .. . Dry Well ... .. . <br /> Zoning Dist. ��..� Conditional Seepage Trench ...... 1C <br /> Land . .. . . . Priv _ <br /> 3. Lot Size 6. Use (describe exactly, 1- Seepage Bed 1�•1L/�"� o <br /> q �•. . ft• glLc•. • fam. home, motel etc.) FOR COMMERCIAL USE <br /> x <br /> ft Plans Submitted . .. .. . �r <br /> sq. ft. ! Plans Approved t ti <br /> NOTE: A preliminary site inspection must be made and site approval granted on all struc- Q : 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 be attached to this application before a <br /> permit will be issued. Do not purchase or ins tali a septic tank, do any plumbing or start any tq <br /> building until a permit has been issued. A permit may be revoked if misrepresentation of 11} o <br /> any of the information conveyed herewith is found to exist. Changes in plans or specifics- 1 \ <br /> tions shall not be made without approval of the Zoning Administrator. SEWER SYSTEM _ C <br /> SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. :fv I <br /> Nil <br /> v <br /> h <br />