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51Y)4)1 <br /> Burnett County Office of Zoning Administrator g 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 V 3 <br /> all work shall be done in accordance with the requirements of the County Zoning Ordinance, t '1 p <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- <br /> lations of the State of Wisconsin. - n <br /> Owner or Agent (please print) Contractor or Surveyor r <br /> 4 fc -Os4..t Al 1-1, N t5 4j r woisco4 _-�, <br /> Address /vW fA- ;51G4.7 Address <br /> h <br /> Phone Phone • <br /> Plumber Well Driller ..) <br /> i <br /> Address Address <br /> 0 <br /> Z/ <br /> Phone Phone a° <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities <br /> Bathrooms ti t <br /> of <br /> C <br /> Type <br /> onsrucon No. '' " a <br /> 1. Work (check one) ' '�'' ` <br /> Dishwasher r <br /> New Building Garbage Grinder <br /> w <br /> Addition Size ft. x ft. Autom. Laundry 'NI • <br /> Sanitary L--- ' No. Bedrooms . .. ' , ; c%, <br /> Alterations Height . .. . Stories . ... Waste Disposal <br /> Moving Area System <br /> Wrecking Septic Tank Size <br /> Mobile Home 5. Permits Required �+ & iJ <br /> Privy Subdivision •• �� Gallons �0 1-�.- <br /> Absorption Field Site - g' <br /> Well Sanitary .t--�----` �. <br /> Soil0.. <br /> Subdivision Building SlopeType + E ° <br /> • • <br /> Well Perc. Rate .1 � ' `' <br /> 2. Classification Other (Specify) Dry Well b 1/4�' W <br /> Zoning Dist. Conditional Seepage Trench ' , <br /> Land Priv <br /> y �`3. Lot Size 6. Use (describe exactly, 1 Seepage Bed pj/f)C!a . <br /> � C o <br /> fam. home, motel, etc.) FOR COMMERCIAL USE •`i y <br /> ?. ft. x(Ice ft. Plans Submitted ,_ k g <br /> sq. ft, Plans Approved ,'b <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- . �' <br /> posal systems, a copy of the percolation test must be attached to this application before ai <br /> permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any t <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. ;', <br />