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"7IV <br /> C <br /> m o 0 <br /> Burnett County Office of Zoning Administrator p <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <br /> :°e :c'' <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 :� n <br /> all work shall be done in accordance with the requirements of the County Zoning Ordinance, :� o <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- <br /> lations of the State of Wisconsin. :J <br /> !.v.r.I^ e.n. . . . ,a�.sa .�, ... ... . . . .. . . .. .. . . .. .. . . .. . <br /> Owner or Agent (please print) / Contractor or Surveyor o <br /> .. .� I . . c�. . S7.SL rrV ' Addr�ssN�.. . / �,/1.:... ... . .. . ... .S <br /> Address '' <br /> . .. . .e.. .... .... .. ... . .... .. . . .. . . .. .. . . . . ..... . . .. .. .. .. ... . .. . . .. . . . . . . .. . . . . . .. . . A <br /> Phon ' <br /> �� <br /> Plumber Well Duller <br /> <N. .S.. . . .. . . . . . . . . . . . # r <br /> Address. . . . . .. ... . .. . . .. .. . . .. . .. . . .. .. .. Address. . . .. .. . . . . . . .. .. .. . . . . . .. . . .. .... . <br /> . .... . ... .. . . . o � J <br /> Phone Phone � <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities <br /> 1. Work (check one) Type of Construction No. Bathrooms . .a- <br /> Dishwasher . . . .. . <br /> New Building ... . . . ... . i`r . . .• • Garbage Grinder . . . . . . } <br /> Addition • •••• • Size . . . . . ft. x .. .. . ft. Autom. Laundry .,... . <br /> Sanitary C �� No. Bedrooms <br /> � . . <br /> Alterations Height . .. . Stories . .. . Waste Disposal <br /> Moving • •••• • Area System <br /> Wrecking ...... Septic Tank Size <br /> Mobile Home . .... . 5. Permits Required '7 S',� Gallons 3 �b � <br /> Privy . • • •• • Subdivision r <br /> .. . . . <br /> Absor tionF�l,d Site // <br /> Well . .. . . . Sanitary .L/. . Soil Type A. .0.. ¢o <br /> Subdivision . . , ,, • Building • .. • • • Slope . . . . .9 <br /> Well n <br /> Pere. Rate . .. . . . . .. . . . r <br /> 2. Classification Other (Specify) , .. ,. . Dry Well . .. . . . :b :(1 <br /> Zoning Dist. Conditional . . . . . . Seepage Trench . ,. . . . A <br /> Land . .. . . . Privy <br /> 3. Lot Size 6. 'be exactly, 1- Seepage Bed <br /> fam. home, motel, etc.) FOR COMMERCIAL USE <br /> . ft. x . . . .. . . ft. Plans Submitted . .... . r <br /> sq. ft, Plans Approved . . . .. . <br /> ay <br /> LA <br /> :W <br /> NOTE: A preliminary site inspection must be made and site approval granted on all strut- .:,I <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 i? <br /> permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any :111, <br /> building until a permit has been issued. A permit may be revoked if misrepresentation of :6 m <br /> any of the information conveyed herewith is found to exist. Changes in plans or specifica- 9'„ <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. :.r .� <br /> (D <br />