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y� O O <br /> I Burnett County Office of Zoning Administrator S <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 E <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu. <br /> lationssI of the State <br /> of Wisconsin. /_� ;� <br /> c{.¢M.. .....11.4. .'.1. .......... �/ ;� <br /> O/w/n�e{r�or Agent (please print) / Contractor'or Surveyor <br /> .............. .... <br /> Address Address � 7 <br /> Phone . .... .... ...�. .... <br /> . ... . Phone! ..... ...... .... ...... . ... .. <br /> p . .................. .... ..... .... .... .... .. .:.. .... .... .. .. ... . .. . <br /> Plum r Well Driller <br /> o. :N <br /> Address Address .` <br /> .................... .. ......... .... ...... .. .... .... .... ... ........... ............. . <br /> Phone Phone �° <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities rr�a rU� <br /> 1. Work (check one) Type of Construction No. Bathrooms <br /> New Building '. <br /> Dishwasher .. . .. <br /> _ Garbage Grinder .. . ... <br /> Addition Size .a.y ft. x 3,6. ft. Autom. Laundry nn <br /> Sanitary No. Bedrooms. <br /> Alterations ...... . Height . ... Stories . ... Waste Disposal <br /> Moving Area ... . ... .... ..... <br /> . . . .. . <br /> Wrecking ...... Septic .J <br /> Tank Size ' <br /> Mobile Home ...... 5. Permits Required 7i <br /> Pnry Subdivision' - S�"' Gallons <br /> Well ..1 Absorption Field Site / <br /> Sanitary ..✓ Soil Type ..5.`!.!k.!.... 55 . <br /> Subdivision ".. .. Building ..�� 0: e <br /> Well Pere. Rate • .I <br /> II//.b Slope ate ... .. . ... ... c <br /> �`'L ..Gl - <br /> 2. Classification Other (Specify) ..... . Dry Well <br /> Zoning Dist. Conditional ...... Seepage Trench . .... . <br /> Land . .... . Privy <br /> S. Lot Size y nnbe1 exactly, I. Seepage Bed - <br /> fam. home, otel, etc.) FOR COMMERCIAL USE <br /> . ft. x ...... . ft. <br /> Plans Submitted . ..... . <br /> . . j. N. ft. o Plans Approved <br /> `L <br /> NOTE: A preliminary site inspection must be made and site approval granted on all strut- <br /> tures involving sanitary.facilities before construction can begin. In the case of sewerage dis- <br /> posalsystems, a copy of the percolation test in ust be attached to this application before a <br /> permit will be issued. Do not purchase or ins tall a septic tank, do any plumbing or slart'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 specir,*ca- <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. "11 <br />