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ON COMP OTER/SCANNED <br />Burnett County Office of Zoning Administrator <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 />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 />lations of the State of Wisconsin. <br />� .1d...�eh.-.... ............. .. Alp rMw4A).M ...... <br />Owner or Agent (please print) Contractor or Surveyor <br />%� ; �:....� �: :.. b.r:........ .).? : .... IN..�bs r .. ... . <br />Address.w St. Pau -1 /1) N 551 j 9 Addre <br />Phone................................... Phone .................................... <br />r(e ..1.0.V.1X. &V1.......... <br />Plumber <br />+.�.. .......................... <br />Address <br />...... �. q. ............... <br />Phone <br />Well Driller ............................... <br />................................... <br />Address <br />Phone.................................... <br />DESCRIPTION 4. Building Details 7. Sanitary Facilities / <br />1. Work (check one) Tylef Construction y No. Bathrooms l <br />New Building ,.y, .... Ir.amt,-. fMw�/n � Dishwasher ... <br />Addition/�j Garbage Grinder ..44 <br />� <br />Size A6 ft. x 4.... ft. Autom. Laundry <br />Sanitary ..).�1. `)rb� . <br />Alterations ...... Height ( V to ies,(CaT ` No. Bedrooms <br />Disposal <br />Moving ...... AreaSystem ...... <br />Wrecking ...... Septic Tank Size <br />Mobile Home ...... 5. Permits Required <br />Privy .... Subdivision Gallons <br />Absorption Field Site <br />Well .... Sanitary .. Type <br />Soil <br />Building <br />..�7R�. <br />Subdivision ...... 7 . , . <br />g y <br />Well (' Slope <br />2. Classification Other (Specify) , , , , . , Perc. Rate .. �-�. .t . . <br />Conditional Dry Well ...... <br />Zoning Dist. Land ...... Seepage Trench ...... <br />Privy <br />3. Lot ize 6. Use scribe exactly, 1- Seepage Bed <br />.IQ. ft x ��ft. am. home, motel, etc.) FOR COMMERCIAL USE <br />Plans Submitted ...... <br />................. sq. ft. Plans Approved ...... <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 <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 />6 - <br />