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m o 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- PN n <br /> lations of the State of Wisconsin. <br /> YY/j/5 'tn..r .!y>4. �sie�s �lM� ... .. .. ...... ..... . .. .. .. .. .. . ... ......... <br /> > er/4.agent (please print) Contractor or Surveyor :U b <br /> F,Q. (/{4� 9'�1.. . ..... .. . ... .. .. .. .. .. .. . ... .. ........ ........ ......... ....... <br /> Address Address <br /> Phone a Phone <br /> -7- / <br /> 41.41? .. .. .. ... . . ..... ... .. .... . . .... . ... .. . ... . . . . . . .. . . . d 9) <br /> umber Well Driller <br /> S. .. l!/�1 x . .. ... .. .... .. .. . . .... .. ....... . ... .. .. .. . � � •`� <br /> Address Address <br /> 94...2.... .. ... .... . .... . . . .. .. . . .... .. ...I.... . .... . .. . .. .. . <br /> Phone Phone <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities <br /> 1. Work (check one) Type of Construction No. Bathrooms . .. . .. <br /> Dishwasher . . ... . <br /> New Building ... ... ........... .. ... .. . .. .. Garbage Grinder . .. .. . <br /> Addition •:•••• e , •,•. ft. x . .. .. ft. Autom. LaundryU <br /> Sanitary No. Bedrooms . . ... . rs :(R <br /> Alterations ...... Height ... . Stories .... Waste Disposal ;t <br /> Moving <br /> ..... Area . .. ... ... .. .. . . .. . System .�., . <br /> Wrecking Septic Tank Size <br /> Mobile Home . ..... 5. Permits Required • , ,,, Gallons m <br /> Privy Subdivision Absorption Field Site <br /> Well Sanitary Soil Type . ............ t <br /> p <br /> Subdivision . .. .• • Building • •••• • Slope ... ..... ... .. .. . <br /> Well ••• ••• Pere. Rate . .. ..... .. . . : <br /> 2. Classification Other (Specify) ..... . Dry Well <br /> Zoning Dist. ...... Conditional . .. .. . Seepage Trench ... ... <br /> Land . .. . . . Privy <br /> 3. Lot Size 6. Use (describe exactly, 1- Seepage Bed ... ... o <br /> fam. home, motel, etc.) FOR COMMERCIAL USE <br /> ....... ft. x ....... ft. Plans Submitted . ..... <br /> sq. ft. Plans Approved ... .. . �t' d <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 m ust 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 <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 p� <br /> SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OF 10E AND APPROVED. <br /> 1-D � 736) y/ 7 f <br />