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b o o <br /> Burnett County Office of Zoning Administrator, i ' <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMITN) <br /> To the Zoning Administrator: The undersigned hereby makes application for N ;'rl�\T <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, <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- :, i ,� 0 <br /> lations of_the State of Wisconsin. <br /> /I ner r... n ... .W..'.. ........ . .. ...... .. ...... .y*o'r- . .... .... .... . .... y. <br /> Dwne�r or Age(�t (please print) � Contractor or Surveyor , m <br /> ..1. ,: i.L.6.9.r�r. ...< . . .... .... . ....... ............................. ..... <br /> Address / Address <br /> S <br /> hory. ........ .... .... ... . .... ... ..... ... . ... ..... ... ......... .... ........ . .. <br /> PPhone <br /> . . :� <br /> [� o n E <br /> (.� / .. .... ........ ... ..... .... ....... .... ..... ... .... .... .... .. .. ... . .. . q g <br /> P u ber WeB Driller <br /> s <br /> Address Address S :(n <br /> O <br /> . ............. .... .... .... ... .. .... .... .. ........ .... . ... .... .... .... ..... .... .... . :) <br /> Phone Phone <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities ��( <br /> 1. Work (check one) Type of Cpnstruction No. Bathrooms . .... . S : `• <br /> Dishwasher <br /> New Building ...... <br /> Garbage Grinder <br /> Addition .z. <br /> Sanitary Size .... . ft. x . ... . R. Autom. Laundry <br /> Ban <br /> .... IN <br /> t'y L� No. Bedrooms <br /> Alterations Height . ... Stories .... Waste Disposal <br /> Moving ...... Area System ...... 1y11 ' ;('�1 <br /> Wrecking ...... """ " ' Septic Tank Size Idae :1r e - ' <br /> ... p ll1 ITT--- <br /> Mobile Home . .... . 5. Permits Required /A (1 d �Gallo7 c � <br /> ... .... .... .. . <br /> Privy Subdivision Absorption Field Site <br /> -� <br /> Well . .... . Sanitary . .... . soil Type 'O c <br /> ... ..... .... . <br /> Subdivision . .... Building :., <br /> Slope ate .. . .. . . .... . G <br /> Well Pere. Rate ... . . .... . .. I 0 . . � <br /> 2. Classification Other (Specify) ...... Dry Well <br /> Zoning Dist. ..... . Conditional . ..... Seepage Trench ,•1 t : `.� <br /> Land Y-J <br /> ...... Privy <br /> 3. Lot Size 6. tribe exactly, I- Seepage Bed . .... . <br /> fam. hom , motel, etc.) FOR COMMERCIAL USE :� f <br /> ... ..4 ft. x ....... ft. Plans Submitted .e <br /> 1 ...... :�' weT.•'' y 1I <br /> . .. .... .. ... . sq. ft. Plans Approved . ..... <br /> NOTE: A preliminary site inspection must be made and site approval granted on all strut- <br /> tures involving sanitary facilities before construction can begin. In the case of sewerage dis- <br /> posalsystems, a copy of the percolation test must be attached to this application before a J{ <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 he revoked if misrepresentation of u <br /> any of the information conveyed herewith is found to exist. Changes in plans or specifics- ' <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 /> lam ` . ` <br />