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el)EZ7711) <br /> a <br /> C7 ,- 2 C---' <br /> go c <br /> Burnett County Office of Zoning Administrator 6'g • <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT •. " 0� <br /> To the Zoning Administrator: The undersigned hereby makes application for I <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, NJ fp <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- p <br /> latio s f the State pf Wisconsin. 0 <br /> 3-1 <br /> Owner or Agent (please print) Contractor or Surveyor v 41. <br /> /.(C.C.../e /(r/ (d.,.5-17,"---7 % <br /> Add \ress Address ' <br /> Phone - Phone N. <br /> 7Mi T-1,4- ,561' 11 d <br /> Plumber Well Driller <br /> i ,ri.. <br /> Address S AZ-/i// •!� Address i Q <br /> Phone Phone N <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities <br /> 1. Work (check one) Type of Construction No. Bathrooms . . l. : r '1 <br /> New Building •,�/P7/ Dishwasher . . NGarbage Grinder 1;,\. <br /> Addition Size k.. ft. x 3 r ft. Autom. Laundry 1 <br /> SanitaryNo. Bedrooms <br /> Alterations Height .. . . Stories /... Waste Disposal <br /> MovingArea System <br /> Wrecking Septic Tank Size C-^ <br /> Mobile Home 5. Permits Required / e <br /> Privy Subdivision • • ••f�QQ Gallons ��' <br /> Well 1...,,,------- <br /> • •j -'� Absorption Field Site / ' <br /> Sanitary • •�— Soil Type /y,(,Y., l`( `e1 R <br /> Subdivision Building / Slope t °5 <br /> Well__ • •!/• Perc. Rate 2_1 a <br /> 2. Classification Other (Specify) ) <br /> ZoningConditional WellL'') <br /> Dist. SeeDrys <br /> 4-- <br /> Land Seepage Trench \ � \)Privy <br /> 3. Lot Size 6. U 'be exactly, 1- Seepage Bed o <br /> �Z.2 . . ft. x ft�M fam. ho , motel, etc.) FOR COMMERCIAL USE a1 I <br /> � Plans Submitted <br /> 2.¢Q.Oc sq. ft. Plans Approved 'c <br /> NOTE: A preliminary site inspection must be made and site approval granted on all strut- ' (3 \., 1 <br /> tures involving sanitary facilities before construction can begin. In the case of sewerage dis- -8. <br /> posal systems, a copy of the percolation test must be attached to this application before a g �. <br /> permit will be issued. Do not purchase or ins tall a septic tank, do any plumbing or start any 4 <br /> building until a permit has been issued. A permit may be revoked if misrepresentation of t , <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 '� 8T <br /> SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />