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X12 Corn P <br /> o y z <br /> Burnett County Office of Zoning Administrator aG � <br /> 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT (4 <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 r 6\ <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- :� y <br /> lotions of the Stateofof Wisconsin. <br /> 0 .. 04 Sn . <br /> Owner or Agent(please print) Contractor or Surveyor <br /> 1.5.? .7......f-i ... .. .... ... ... .... ................................ }' <br /> Addresls' Address <br /> Phone Phone , <br /> Plurn r Well Driller ��,. <br /> . .... . ... ...... .... .... ........ . .... Address... .... .... . ... .... ....... . . .. ....... S �' <br /> Address <br /> . .. ' ........ ...... . ....... .. ... ..... .. ........ ..... ........ . <br /> Phone... .... ........ .. ... Phone a <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities ! ^ <br /> 1. Work (check one). Type of Construction No. Bathrooms .. .. . S ;M <br /> g ..(-.� ..�.!`.9�^.:.�. ... .... Dishwasher <br /> New Buildin <br /> Garbage Grinder <br /> Addition Size AY. ft. x k, ft. Autom. laundry <br /> Sanitary .✓.... No. Bedrooms <br /> Alterations ...... Height ... . Stories ••- Waste -�I <br /> Disposal <br /> ...... Area ... ... ; u <br /> Moving System <br /> Wrecking ...... ... ........ ...... . Septic Tank Size c <br /> Mobile Home ...... 5. Permits Required <br /> Privy, .7::i..4... Gallons rr111A" <br /> Subdivision c j <br /> Well ..tl... '� Absorption Field Site A 1 <br /> Sanitary ..�.... SCL-.+�� <br /> Soil Type . .... ... 5 <br /> Subdivision ... .. . Building Slope .I r.... o °o <br /> Well - .,__..! un,.��. .�.. p <br /> ate <br /> 2. Classification ��^� Other (Specify) Dryc Well ... ... p <br /> __„_ Conditional . <br /> Zoning Dist. [and ...... Seepage Trench - ... ... h ;� <br /> .... . . Privy <br /> 3. Lot Size 6. se-(describe exactly, I. Seepage Bed <br /> tam. m <br /> hoe,)motel, etc.) FOR COMMERCIAL USE e <br /> ....... h, x ....... ft. Plans Submitted ..... . <br /> t. P eq. ft. Plans Approved . ..... <br /> \ -4 <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- i <br /> posal systems, a copy of the percolation test must be attached to this application before aC <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. T <br /> :C f <br />