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d y z <br />Burnett County Office of Zoning Administrator u <br />0 <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, 0 <br />Sanitation Code, and with all other applicable County Ordinances and the laws and regu. :V '^ A <br />lations of the State of Wisconsin. K <br />T. �t <br />........�� r-... VDr-r &U. ...... .......................................... <br />Owner or Agent (plea�•se print) Contractor or Surveyor <br />RPt....1...�� 7cZ.�� ................................. <br />Address <br />Phone................................... Phone .................................... <br />t ui C' 13 wW 4. PAP u......... <br />W <br />Plumber ell Driller <br />Address Address <br />Phone Plione � : "� ' <br />DESCRIPTION 4. Building Details 7. Sanitary Facilities <br />1. Work (check one) Type of Construction No. Bathrooms ...... <br />New Building ...... ......•••.•............ Dishwasher ...... .+ <br />Garbage Grinder ...... <br />Addition Size ..... ft. x ..... ft. Autom. Laundry ... :-•c <br />Sanitary . • .... No. Bedrooms . <br />Alterations ...... Height .... Stories .... Waste Disposal <br />Moving ...... Area System ...... <br />Wrecking ...... . ' . . . ' ' . ' ' . • . ' ' ' . ' Septic Tank Size 1 <br />Mobile Home ...... 5. Permits Required + <br />14:'V ..... Gallons <br />Privy Subdivision Absorption Field Site <br />Well ...... Sanitary.. Soil TypeS-4N U <br />Subdivision ...... Building <br />. t7 <br />...... Slope ...... � � � <br />Well <br />Other (Specify) . . . . . 4 Pere. Rate G �''9 <br />2. Classification p y Dry Well <br />Zoning Dist. ...... Conditional • • • • • • Seepage Trench • �� <br />r <br />Land ...... <br />Privy <br />3. Lot Size 6. Use (describe exactly, 1- Seepage Bed /14 ...... C,: 1 c <br />fam. home motel etc. <br />x ! . .. ft. ) FOR COMMERCIAL USE <br />`i,r y DW0 L.G 41 Plans Submitted ...... <br />................. sq. ft. Plans Approved ...... ; 'd <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 m ust 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 />