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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 y :� <br /> a Permit for the work described and located as shown herein. The undersigned agrees that f� <br /> all work shall be done in accordance with the requirements of the County Zoning Ordinance, n o <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- <br /> lations of the State of Wisconsin. <br /> �.o. .a...c.Y...l�. ,..l.�.a.. ..... C.a.M�t. .rau a G <br /> Owner Age (please print) Contractor o ;v <br /> . <br /> r eyor <br /> ...Z)a.rQ.)�).L%1 . CJ.! S C l.. . . .... (� P <br /> �..�. Address. . . .. ...... <br /> Address <br /> :n <br /> .. . . .. ......... ...... ...... . ..... .... .. .. .. . .. . . <br /> Phone Phone <br /> .. . JN Nie/ ... . . .. . -� <br /> Plumber Well Driller - F <br /> . . . ... .. . . .. .... .. . ... .. .... ... ... . .. .... <br /> Address Address � (� <br /> .. .. .. . . .. .. . . <br /> Phone Phone <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities :� <br /> 1. Work (check one) Type of Construction No. Bathrooms .. ... . S :M <br /> �yr Dishwasher . .. ... <br /> New Building 11. . ......••• .. ... . • Garbage Grinder <br /> Addition g <br /> ,✓/ Size o,Z� ft. ��. ft. Autom. Laundry <br /> Sanitary h•• No. Bedrooms . .. ... <br /> Alterations ... ... Height J. Stories .... Waste Disposal Irk <br /> Moving ..... . System ... .. . <br /> Wrecking ...... Area Septic Tan Size�t <br /> Mobile Home . ..... 5. Permits Required a•SOD, Saos Gallons 0' + J <br /> Privy . .... • Subdivision .. ... . I <br /> Well y Absorption Field Site <br /> -•A• • Sanitary Soil Type ... .. ... .... . c <br /> Subdivision .. . .. . Building Slope . .. .. .. . . .. .. .. . cJ <br /> Well <br /> Other (Spec Pere. Rate . . . . <br /> 2. Classification ) Dry Well . .. . . <br /> Zoning Dist. 1�� Conditional . .... . Seepage Trench . . . ,. . <br /> Land ... .. . Privy <br /> 3. Lot Size 6. Use (describe exactly, 1- Seepage Bed#0 <br /> fam. home, motel, etc.) FOR COMMERCIAL USE <br /> ....... ft. x ...... , ft. Plans Submitted . .. .. . <br /> . .ZQ9�.w.<A . 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 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 1n� <br /> SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />