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- eZ <br /> Burnett County - Office of Zoning Administrator ie P <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, :�f <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu. `I e <br /> lations of the State of Wisconsin. /� • `� :)�g <br /> �....11.•�LS.?.l.l....... .. .. ... .. . .... .... ..... . .. . ... ....... <br /> Owner or Agent (please print) ^ Contractor or Surveyor <br /> Address Address ; c <br /> Phone . I �. <br /> ... . .. .. . bn <br /> Ptum r Well Driller ,`� <br /> s <br /> Address... .......... .... .... ... .... ...... Address � <br /> ........ .... .... .... ............. . 8 :o <br /> .. . ..... .... .... .... ..... .. .. .... .. ........ <br /> Phone <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities <br /> 1. Work (check one) Type I Construction No. Bathrooms ...�. ; E <br /> Dishwasher . .... . <br /> New Building ..G`-1 •• •••rp� • <br /> Addition � 1 3.0 Garbage Grinder . .� <br /> Sanitary Size ft. x 00 ft. No. Be foundry . . .. <br /> Alterations ...... Height No. Bedrooms .. <br /> O <br /> Stories .... Waste Disposal : W '� d <br /> Moving ...... Area ... ...System :n <br /> Wrecking ...... . ........ .. .... .. . Se tic Tank Size <br /> Mobile Home ... ... S. Permits Required . ...� � Gallons y $j <br /> Privy / Subdivision Absorption Field Site / ' '� P' <br /> Well .+f Sanitary :.� Soil Type . :�.Y.n..C!. . 5 o r� <br /> Subdivision ... ... Building ... ... <br /> Slope . ....... . ...... . o <br /> WellPerc. Rate d r• <br /> Other (Specify) ...... "' " .... <br /> 2. Classification y) <br /> Conditional Dry Well -0 v9 <br /> Zoning Dist. ...... Seepage Trench <br /> Land ..... ... ... <br /> lJ i <br /> 3. Lot Size 6. U4escribe exactly, 1- Seepage Bed ... . . . :� e <br /> � L _ am.. ham,motel, etc.) FOR COMMERCIAL USE <br /> . ft. x . n. f - Plans Submitted . ..... <br /> :h B <br /> . ... . .... .... .... sq. ft. Plans Approved ... .. . :, v <br /> NOTE: A preliminary site inspection must be made and site approval granted on all struc- 'G <br /> lures involving sanitary facilities before construction can begin. In the case of sewerage dis- <br /> posal systems, a copy of the percolation test mpust be attached to this application before a :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 />