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G H Z <br /> 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, p <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- <br /> lations of the State orf/Wisconsin. <br /> �h3rl-ey <br /> Owner or Agent (please print) Contractor or Surveyor <br /> Address Address <br /> 65-(- 7.29 GJ y <br /> Phone ..... .. .. .......... .. ........ .. .. .. Phone ......... ...... .. .... .. . . .. .. . . ... . . :" <br /> Plumber . .......... .. . . ....... ... .. . ... . . Well Driller c� �; : <br /> W11 CS'v <br /> Address. .. ........ .. .. .. ....... .. Address....... .. .. .. . ...... . . . .. .. ..... <br /> Phone .. .............. .. ....... .. .. .. .... Phone .. .. .. .. .. .. .. . . ........... ...... .. , <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities <br /> 1. Work (check one) Type of Construction No. Bathrooms . .. ... <br /> New Building . . . •• <br /> i116c'; 'n Dishwasher . .... . <br /> •••• � <br /> Addition ?;,, <br /> Sanitary .. � " t.' Garbage Grinder . ... . +• <br /> Size .%X. <br /> ft. x Autom. Laundry . .... . <br /> . No. Bedrooms . .. ... <br /> Alterations ...... Height ... . Stories Waste Disposal •'� <br /> Moving ...... Area System ; <br /> Wrecking .... Septic Tank Size <br /> Mobile Home . ..... 5. Permits Required <br /> /Q t) f0. ... Gallons <br /> Privy • Subdivision Absorption Field Site <br /> Well • Sanitary • •• •• • Soil Type •y o <br /> Subdivision ... ..• Building . ..... . Slope : <br /> . .. .. .. .. .. .. .. . <br /> Well Perc. Rate <br /> 2. Classification Other (Specify) . .. .. . Dry Well -F <br /> Zoning Dist. �?• ..; Conditional Seepage Trench <br /> Land . .. .. . Privy . .. .. . r ; <br /> 3. Lot Size 6. Use (describe exactly, 1- Seepage Bed . .. ... c <br /> ,f jm'Anome, motel, tcJ� FOR COMMERCIAL USE <br /> Q(% Plans Submitted <br /> y. sq. ft. � Plans Approved . .. ... <br /> v <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 />