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0 H z <br /> Burnett County Office of Zoning Administrator 9 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT O M <br /> To the Zoning Administrator: The undersigned hereby makes application for <br /> , � <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- <br /> la/tions of the State of isconsin. <br /> Own4 or Agent (please print) Contractor or Surveyor ^�o <br /> . . . . . . . . . .. . . . ... .. ............... . <br /> Address Address <br /> irk�.-..Zl/.�.......... . . . . . . . . . . . . . . . . . . . .. .. . . . . . . .. . . .. . . . . . .. . . :r <br /> Phone Phone <br /> t7 :O <br /> Plumber Well Driller <br /> . . . . . . . .. . . . . . . . . . . . .. . . . . . <br /> Address. . . . . .. . . . . . . . . . . . . . . . . . . . . . .. . ... Address •o <br /> Phone .. . . . . . . .. .. . . . . .. . . . . . . . . . .. . . .. . . Phone . . . . . . . . . . . . . . . . . . .. . . . . . . . . .. . . . . . . <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities <br /> 1. Work (check one) Type of Constructio/,n J No. Bathrooms v SQ:� <br /> New Building ...... . ..�'/�F 1�...4°�: �c ` Dishwasher . . . .. . g! <br /> Addition �� ^ �.� Garbage Grinder . . . . . . <br /> Size :. . ft. x Autom. Laundry <br /> Sanitary i No. Bedrooms <br /> Alterations .. .... Height,,2 Stories ,/ Waste Disposal y' <br /> Moving Area . �`, . . . . . . ijlE� System `I• <br /> Wrecking . .. . .. v Septic Tank Size <br /> Mobile Home . . . .. . 5. Permits Required `ala <br /> y Subdivision <br /> rA <br /> Privy :�` R <br /> • • • • • • Sanitary <br /> Well Absorption Field Site " <br /> f/ <br /> Subdivision • • • • • • Building , Soil Type . . . . . . . . . . . . . : ) ? c <br /> Slope . .. . . .. . . . . . . . . . c d <br /> Well p <br /> (Specify) Pere. Rate <br /> 2. Classification y) , , . Dry Well :,� ,;� 9Q), <br /> Zoning Dist. . .. .. . Conditional . . . . . . Seepage Trench . . . . , . j :0 Q!9 <br /> Land Privy . . . . . . <br /> 3. Lot Size .1��>3 6. Use (describe exactly, 1- Seepage Bed . . . . . . <br /> ft. <br /> a Q p. x 0. fam iom motel, etc.) FOR COMMERCIAL USE <br /> / !... Plans Submitted . . . .. . :P i <br /> sq. ft. Plans Approved . . . .. . v ` <br /> •1 <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- C O <br /> posal systems, a copy of the percolation test m ust be attached to this application before a Al <br /> permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any obey <br /> building until a permit has been issued. A permit may be revoked if misrepresentation of ;� o <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 />