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a <br /> Z <br /> Burnett County Office of Zoning Administrator g. t <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT M <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, :5j .Dj p <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- f <br /> lati n of the State of Wi c nsin. �W �•n <br /> r. J. .. o.a.m.(34 ► <br /> Owner or�ent (please print) Co Addressntractor or Surveyor <br /> Addr <br /> .I?. rV. . . .. . . .. . . <br /> ..... .... .. . <br /> ess <br /> ..... .. .... .... .. .... .. .. .. ... . .. .. . . .. . . . . . .. . . <br /> Phone 1 ! Phone CA <br /> Plumber Well Driller (� <br /> j� o <br /> . ... .. . <br /> . .. .. .. . .. .. . <br /> Address Address <br /> Phone Phone sego /l er <br /> DESCRIPTION 4. Building Details 7. Sanitary Facihtie <br /> 1. Work (check one) Type of Construction No. Bathrooms <br /> Dishwasher ..... . � (" <br /> New Building ... .. . ....... .. .. ... .. ..••• •• Garbage Grinder . .. .. . <br /> Addition •� • Size . . . , . ft. x . . .. . ft. Autom. Laundry <br /> Sanitary No. Bedrooms . .. .. . <br /> Alterations ...... Height . .. . Stories . ... Waste Disposal <br /> Moving Area System <br /> Wrecking ...... Septic Tank�� Size : <br /> Mobile Home . .... . 5. Permits Required ,aZ v� Gallons <br /> Privy . •••• • Subdivision <br /> W Absorption Field Site <br /> Well <br /> Sanitary �'i Soil Type ~' <br /> Subdivision . .. .. . Building . .. .. . S . .. ....... ... <br /> Slope . .. . ... .. . . . ... . c � <br /> Other (Specify) Pere. Rate . .. . . . . .. . . . : <br /> 2. Classification ••••• • Dry Well . .. . . . Q <br /> Zoning Dist. ...... Conditional • •. •. . Seepage Trench . .... . <br /> Land Privy : <br /> 3. Lot Size 6. Use (describe exactly, 1- Seepage Bed . .. . . . c <br /> ft. fam. home, motel, etc.) FOR COMMERCIAL USE <br /> ft. x rA <br /> Plans Submitted . .... . <br /> . .. .. .. .. . ... .... sq. ft. Plans Approved . .. .. . <br /> NOTE: A preliminary site inspection must be made and site approval granted on all strue- : <br /> tures involving sanitary facilities before construction can begin. In the case of sewerage dis- <br /> posal systems, a copy of the percolation test m ust be attached to this application before a Q <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 d <br /> SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />