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0 <br /> Burnett County Office of Zoning Administrator 6 <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 <br /> ail work shall be done in accordance with the requirements of the County Zoning Ordinance, O® p <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- <br /> lations /�oJq the State of W' cousin. / <br /> �/0/Jl/.. . ..... . . . . . �,�!..� UGLr . . . . +� o <br /> Owner or Agent (please print) Contractor or Surveyor \ <br /> �s <br /> . .. .. . . <br /> . . . . .. .. . . ...... ... ... .. .. .... ... <br /> Address <br /> Address Sy , <br /> Phone Phone <br /> C <br /> Plumber Well Driller X <br /> . . . . .. .. . . .. . <br /> Address Address � <br /> Phone.. <br /> . ... .. .. .. . . .. . . . . .. .. ... . .. ... . .. . .. .. . <br /> Phone � • <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities / <br /> 1. Work (check one) Type o Construction No. Bathrooms <br /> ` ft. Garbage Dishwasher <br /> aundry . <br /> New Building r <br /> Autom. <br /> Addition Size <br /> Sanitary . .. ... No. Bedrooms Z_. <br /> Alterations ...... Height /A."Stories Waste Disposal <br /> Movie ... ... System <br /> Wrecking <br /> g Area ... .�0�..3 Septic Tank Size <br /> Mobile Home . .... . 5. Permits Required ' <br /> Privy . .. .. . . .. .X)p. . .. . Gallons P <br /> vision . .... . Absorption Field Site <br /> Well Sanitary <br /> Soil Type . .. .. . .. .. .. . <br /> Subdivision Building ✓. . °c <br /> Well . .. ..• Slope . .. .... .. .. . . .. . J <br /> (S Pere. Rate . . . . . .. . <br /> Other (Specify) . . <br /> 2. Classification �j�� 'J P y) Dry Well ✓.. . <br /> Zo: Conditional • ••• • • Seepage Trench . . . .. . <br /> Land . .. . . . Privy <br /> (`l <br /> 3. Lot Size 6. Use (describe exactly, 1- Seepage Bed . .. . . . e <br /> �fIQ. x0 fam. home, motel, etc.) FOR COMMERCIAL USE <br /> Plans Submitted . .. ... �r <br /> f3. .. . . sq. ft. Plans Approved . .. .. . b J` <br /> • J <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 a <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 A <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 V <br /> SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. Q <br />