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i <br /> .11/ , (1,,,Y) /i <br /> C <br /> d 0 <br /> Burnett County Office of Zoning Administrator in g • <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT �J�� <br /> To the Zoning Administrator: The undersigned hereby makes application for ��- �T <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, �. p <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- ' ' E <br /> is <br /> lations of the State of Wis ons' . ' ..1,/ / / rJ <br /> Owner or Agent ( lease print) Contractor or Surveyor -'N•. ,' ..\. )- --?-1-077 / bleirAddress 9 Address .� <br /> Pho Phone : ` <br /> •;bile& 4 vol c.)/ /-? <br /> Plumber Well Driller A e <br /> Address Address s, <br /> Ct <br /> Phone Phone 0 <br /> • <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities f lN, <br /> 1. Work (check one) Type of Construction No. Bathrooms / �� <br /> Dishwasher U �* <br /> New Building Garbage Grinder ��11 <br /> Addition Size ft. x ft. Autom. Laundry . U. .� <br /> Sanitary .No. Bedrooms . . . <br /> Alterations Height . .. . Stories . ... Waste Disposal <br /> Moving Area System <br /> Wrecking Septic Tank Size <br /> Mobile Home 5. Permits Required �j <br /> cn .* <br /> Privy Subdivision �u "' Gallons <br /> Well Absorption Field Site 0 ' <br /> Sanitary • •1 Soil a <br /> Subdivision Well Building Slo Type • o \s) <br /> • Perc. Rate o J' <br /> 2. Classification Other (Specify) Dry Well <br /> Zoning Dist. Conditional Seepage Tren 4V <br /> Land Privy <br /> 3. Lot Size 6. Use (describe exactly, 1- Seepage Bed -V c _ <br /> fam. home, motel, etc.) FOR COMMERCIAL USE g '_' <br /> ft. x ft. Plans Submitted e <br /> e.), ad.re . _ - Plans Approved 'b <br /> NOTE: A preliminary site inspection must be made and site approval granted on all struc- 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 <br /> permit will be issued. Do not purchase or ins tall a septic tank, do any plumbing or start any ea I <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 :M <br /> SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. "� <br />