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z <br /> I <br /> i Burnett County Office of Zoning Administrator P <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT S. <br /> 1 <br /> To the Zoning Administrator: The undersigned hereby makes application for <br /> l a Permit for the work described and located as shown herein. The undersigned agrees that v \ <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. o <br /> lations of the State of Wisconsin. <br /> •. .4.w:,re.^.s.C..�....fl.S .�C.1f�.F.F . /� C 4Jr �,T�„ <br /> Owner or Agent (please print) ,Centracto 'or Surveyor P <br /> ^t1 <br /> o l ... 'A 3.rd Nv. A/,in1. IV ; <br /> Address Address •• �• �SJ/%a- i.� �� <br /> :s <br /> ..... ........ ...... .. ... . .... ... ... . . ... . <br /> .. .... .... .... .... .... ... . .. . . ... ... . ;n <br /> Phon /J s— � Phone <br /> .. .1 t7 . Cdt <br /> Plu ber . ... .. ........... ... . . .. .. Well Driller.... .. .... .... ... .... ... .. .. . . . ^ �. <br /> Address Address 8 .� <br /> ... ... .... .... .. ............... .......... Phone...... ........ .... ...... ............... ... •� <br /> Phone <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities <br /> 1. Work (check one) 'lYPe of Construction Na. Bathrooms . ... .. S �„ <br /> Dishwasher . .. .. . <br /> New Building ..L� .../.. .!�.Q.'.T.^.�.. ... .. <br /> Garbage Grinder <br /> Addition -- / Size .e1.4. ft. x 3. <br /> Sanitary (i �7 it. No. Be Laundry ... .. <br /> Alterations ...... Height . ... Stories .... <br /> No. Bedrooms <br /> Waste Disposal <br /> Moving ... ... Area System .. . .. . <br /> Wrecking ...... ... .. ... ..... .... . Septic Tank Size a <br /> Mobile Home. ... ... 5. Permits Required / d- S.5. ... Gallons <br /> y <br /> Privy --k Subdivision Absorption Field Sit; <br /> Well � Sanitary ! Soil Type $4.P.d 55 N <br /> Subdivision . .. ... Building 6/. . Slope <br /> ... '.^+0st.n,•..•.... p 0 <br /> Well Pere. Rate <br /> 2. Classification Other (Specify) Dry Well ZoingtW Conditional ... Seepage Trench ... <br /> —1 <br /> S <br /> ui <br /> Land . .. . .. Privy (J <br /> 3. Lot Size 6. Use�descjibe exactly, I- Seepage Bed /..40.y rN e w <br /> am. home, motel, etc.) FOR COMMERCIAL USE £p i <br /> ....... ft. x .. ..... ft. Plans Submitted ..... . 1j <br /> 'i E C <br /> . �..C,`.0.C9.O•.0 aq. ft. Plans Approved . ..... <br /> JJ j <br /> .p G p <br /> NOTE: A preliminary site inspection must be made and site approval granted an all struc- <br /> 1Z_tures involving sanitary facilities before construction can begin. In the case of sewerage dis. <br /> poral 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 /> I <br /> - I <br />