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__- _77 792 . <br /> C- <br /> 2 <br /> Burnett County Office of Zoning Administrator g g <br /> *---"g- <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 C� <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- 0 <br /> lati s of the State of isconsin. K <br /> 0a.rre/ ierS6/7 <br /> -,. _ <br /> er or Agent (please print) Contractor or Surveyor <br /> t.ffl3ox./9.7d- i'1 t <br /> Address Address <br /> Phone Phone <br /> C g • <br /> Plumber Well Driller 3 <br /> O <br /> Address Address <br /> E <br /> Phone Phone g • <br /> a. <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities • <br /> 1. Work (check one) Type of Construction No. Bathrooms g <br /> Dishwasher <br /> New Building <br /> AdditionwGarbage Grinder + <br /> Size ft. x ft. Autom. Laundry <br /> Sanitary <br /> Alterations Height ... . Stories ..,, No. Bedrooms <br /> Waste Disposal <br /> Moving Area System f1� <br /> Wrecking Septic Tank Size i l 1 <br /> Mobile Home . / 5. Permits Required � <br /> vy 1/ , <br /> Subdivision Gallons ° <br /> o� - <br /> Absorption Field Site g' <br /> Well Sanitary Soil Type 8: <br /> Subdivision Building Slope o' t <br /> Well Pere. Rate es <br /> 2. Classification (Specify) Dry Well '0 61 <br /> Zoning Dist. Land Privy <br /> Seepage Trench NiCA <br /> Privy v <br /> 3. Lot Size 6. Use (describe exactly, 1- Seepage Bed <br /> fam. home, motel, etc.) FOR COMMERCIAL USE <br /> ft. x ft. Plans Submitted 5r <br /> PIP- a21—($ -ecf.-.ft..-- Plans Approved < 7 <br /> Oa <br /> ,,, . 8 <br /> NOTE: A preliminary site inspection must be made and site approval granted on all struc- <br /> tures <br /> � <br /> 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 1) 04 <br /> permit will be issued. Do not purchase or ins tall a septic tank, do any plumbing or start any 2 <br /> building until a permit has been issued. A permit may be revoked if misrepresentation of ___O nt <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 />