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d c 0 <br /> Burnett County Office of Zoning Administrator :l <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 /> lati s of the State of Wisconsin. <br /> . e�nr.. .. ............ <br /> Ow�nf r or Ant (please�rint) Contracto�ar�orr Surveyor <br /> ,,L ; <br /> Address S7; u� /V/N 5 �/3 Address ; <br /> . .... . ..... .. .. . . .... .. .. . . . . . . .. . . . . : I` <br /> Ph ne Phone ;� <br /> �^ . .. .. . . .. . ... . .. .. . . . . .. ... . . . .. . . .. . . . . <br /> Plumber Well Driller <br /> S! ) . . . . . ... .. . .. .. .. . .. .. .. .... . <br /> Address Address �« <br /> o <br /> Phone .. .. .. . . .... .. .. .. .. .. .. . .. .. .. .... Phone . . . . .. .. .. . . . . . . . . .. .. .. . . . . ... .. . . . <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities <br /> 1. Work (check one) Type f Construction No. Bathrooms <br /> Dishwasher <br /> New Building Garbage Grinder <br /> Addition <br /> t on , ,!� Size .�C(�? ft X38 Autom. Laundry <br /> San <br /> �' ��'O0 Y /CX/ 4� No. Bedroom <br /> s �e`Z j <br /> Alterations ...... Height . .. . Stories .... Waste Disposal <br /> Moving ...... Area System : <br /> Wrecking ...... Septic Tank Size ' <br /> Mobile Home . .. ... 5. Permits Required a`, ''' I, ( 1 <br /> Privy Subdivision /, ' O '•• Gallons <br /> Well Sanitary � Absorption Field Site <br /> Subdivision . .. .. . Building Soil Type . .. ..... .. ... c <br /> Well y✓ Slope . .. . . .. 0 <br /> Pere. Rate . .. . 3. . . ��. <br /> 2. Classification Other (Specify) Dr Well ... <br /> Zoning Dist. ... ., , Conditional •• • • • , Seepage Trench <br /> Land . .. .. . Privy �' �(.,�(�' , � Qj <br /> 3. Lot Size 6. Use (describe exactly,C- Seepage Bed V c <br /> SQ ft. x .�?�U ft• fam. home, motel, etc.) FOR COMMERCIAL USE : :5 : { <br /> Plans Submitted <br /> . .. .. .. .. . . .. ... . sq. ft. 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 o <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 n 01 <br /> SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />