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,f <br /> � o 0 <br /> Burnett County Office of Zoning Administrator >a P <br /> APPLICATION FOR SANITARY — LAND USE -BUILDING PERMIT •� <br /> 't... <br /> To the Zoning Administrator. . The undersigned hereby makes application for ,0 <br /> a Permit for the work described and located as shown herein. The undersigned agrees that r; <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. �' e <br /> lations of the State of Wisconsin. ; <br /> Nrrs�rl�!..... {�?.. ..�.:..':::. <br /> Owner or Agent (please print) Contractor or Surveyor <br /> : <br /> ,3yores,51. <br /> Adds Address <br /> ..... .... ........ .. . .1.1.5.:. .35..-n.z 73.. <br /> Phone . .. .. .. .... .. . . P.hone . .. .. :V\.X.,jer.' ty <br /> . . . . . . . <br /> Plumber Well Driller :? <br /> Q er I�1Z 8 Nr n1i L S�. /q;�e .r <br /> Address Add <br /> .�i.6.-.`fSS7. .. .... 7� 5- 835- I�iiB ' <br /> .. . <br /> Phone ,phone h L <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities ? ' <br /> 1. Work (check one) Type of Construction No. Bathrooms . .. . . . � � '•�C,o u I (J i d e Dishwasher N <br /> New Building1199�� <br /> 4...�1.�......... Garbage Grinder ..... . :_k : <br /> Addition Size p2 0.. ft. x ft. Autom. Laundry ..... . <br /> Sanitary . ..... No. Bedrooms <br /> Alterations ...... Height $. . Stories .I.. . Waste Disposal <br /> Moving ... ... Area .�.4�.S .:.F� system ... .. . <br /> Wrecking ...... a Septic Tank Size r <br /> Mobile Home 5. Permits Required ' <br /> Privy :.,•,•� Subdivision • •• •• J`n Fl •• Gallons <br /> Well {� Sanitary ..... . SoilAbsoT� Field Site <br /> ..:�. . Soli ... .. . ....... <br /> Subdivision .. ... . Building ••V• • Slope . .. .. .. . . ... .... 4, e <br /> Well �•• Perc. Rate <br /> 2. Classification �/ Other (Specify) ..... . Dry Well <br /> Zoning Dist. oke>;.Z Conditional Seepage Trench ... ,.. � <br /> Land ... .. . ,:^ <br /> 3. Lot Size 6. Use (describe exactly, 1- Seepage Bed . .... . c <br /> fam. home, motel, etc.) FOR COMMERCIAL USE <br /> 'f5.7J.9ft. x J.O.a:'ISft. <br /> ecreAi•c,ea1 go,,,e Plans Submitted . ..... : 3 <br /> .�..zr.�. . ... ... aq. ft. Plans Approved ...... : �- <br /> ti: k 1 <br /> NOTE: A preliminary site inspection must be made and site approval granted on all struc- 1ti :Z <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 t; <br /> permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any ;T f <br /> building until a permit has been issued. A permit may be revoked if misrepresentation of <br /> any of the information conveyed herewith is found to exist. Changes in plans or specifics• <br /> tions shall not be made without approval of the Zoning Administrator. SEWER SYSTEM �Ft <br /> SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. S .� <br /> ai <br />