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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, <br />Sanitation Code, and with all other applicable County Ordinances and the laws and regu- <br />lations of the State of Wisconsin. <br />Q <br />0.o. a.�e.Y...�.�..1.�.�. -e-...... C.Q�l�..x:aL .......... <br />Owner Xi4t (please print) Contractor or �rveyor <br />.�.►ti<�. (,�. ! .S. C, :.......................................... <br />Y <br />Address Address <br />......................................... <br />Phone <br />Plumber <br />.......................................... <br />Phone <br />Well Driller ............................... <br />Address.................................. Aaaress................................... <br />Phone................................... Phone .................................... <br />DESCRIPTION <br />1. Work (check one) <br />New Building.. <br />Addition <br />:� : . <br />Sanitary <br />. <br />Alterations <br />...... <br />Moving <br />...... <br />Wrecking <br />...... <br />Mobile Home <br />...... <br />Privy <br />Well <br />Subdivision <br />...... <br />2. Classification <br />Zoning Dist.l� . <br />3. Lot Size <br />....... ft. x ....... ft. <br />o. A ie.,cA . <br />4. Building Details <br />Type of Construction <br />Size c2 jr ft. xp?q—. ft. <br />Height ..1. Stories .... <br />Area.................. <br />5. Permits Required <br />Subdivision ...... <br />Sanitary <br />Building <br />Well <br />Other (Specify) ...... <br />Conditional ...... <br />Land ...... <br />6. Use (describe exactly, 1- <br />faam..'home, motel, etc.) <br />1 r -)-j <br />7. Sanitary Facilities <br />No. Bathrooms ...... <br />Dishwasher ...... <br />Garbage Grinder ...... <br />Autom. Laundry ...... <br />No. Bedrooms <br />Waste Disposal <br />System ...... <br />Septic Tan Size <br />j; ,-S700 _Q e'O Gallons <br />Absorption Field Site <br />Soil Type ............. <br />Slope ................ <br />Perc. Rate ............ <br />Dry Well <br />Seepage Trench <br />Privy ..... <br />Seepage Bed ,*O X <br />FOR COMMERCIAL USE <br />Plans Submitted ...... <br />Plans Approved ...... <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 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 <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 />r J*+T, Ac; n <br />C, o <br />S <br />9 <br />is <br />oa <br />M <br />p <br />C, o <br />S <br />9 <br />is <br />oa <br />M <br />