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G�'t Yc <br /> _ " Office of Zoning Administrator <br /> 0 0 <br /> 3 £ <br /> '-Burnett t �' USE �BUII;DING PERMIT <br /> Count °SANITARY — LAND_, _ p <br /> TION FOR application fora _ <br /> �APPL76N .ADMIN ADMINISTRATOR ATOft �he under signed hereby makes a p , <br /> Tp-THE ZONING d located as.shown herein the'Cpdersi n n agrees that e, x :�i'• <br /> .t f the work descnbed'a^ re uiremen is of the County Zoning Ordinance <br /> v o�anceSv�,th lhe, . 9 Ord mantes and the 1 ws and regu <br /> work shall be lona fifi (,cable CoUniV - - c O <br /> San ^a v' Code, nd th a❑ nt er ap <br /> late of the stare r w e ., I -77 <br /> . . <br /> Contractor or SurSevm c I "^ <br /> Owner or Agent (pleasefprint) ,/ :o <br /> `v l7 r¢✓ _ J Z <br /> Address <br /> Address g�✓ ; .- / m � ��• <br /> Zoao �tel�k _ �rin.h . . sS x.75 . . . . . . . . . . . . . c <br /> -v/ Phone <br /> Phone � .�J <br /> L L ,�� PfTos� <br /> ..•. . . . . . . . .�. . . . . . . . . . . . . . . Well Driller <br /> .-'✓� Plumber <br /> sae.. k ^: <br /> n <br /> Address <br /> . . . . . . . . . . . . . . . . . . . . . . . . . Address o 0 <br /> . . s Xl ej <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 'Phone.. . . . . . . . . . . . . . . . . . . . mmm <br /> Phone. o <br /> a' ;n <br /> o <br /> DESCRIPTION 4. Type 7. Sanitary Facilities <br /> Building Details <br /> - Type of Construction No. Bathrooms . . . . . . o 0 9 <br /> 1. Work . . . . .!�?.:M.�. . . . . . . . Dishwasher . . . . . <br /> New Building L� Size a1. .S ft, x D. b . it. Garbage Grinder . . . . . . _ ;�;� < <br /> Addition . . . . . . Height . . . . . Stories . . . . . . Autom. Laundry . . . . . . <br /> Sanitary Area No.Bedrooms . . . . . . \ r <br /> Alterations . . . . . . Waste Disposal System o» <br /> Moving 6 Permits Required Septic Tank Size Gals. <br /> Wrecking . . . . . . Subdivision . . . . Absorption Field Site - i(^ <br /> m <br /> Mobile Home . . . . . . Sanitary Soil Type . . . . . . .. . . . . . . . . <br /> Privy Building Slope . .. . . . . . . . . . . . . . . . . . m �^ .G + <br /> Well Well Pere. Rate . . . . . . . . . . . . . . . . . 6Q, s <br /> Subdivision . . . . . Other (Specify) .. . . . Dry Well . . . . . . p. 1 <br /> Conditional . . . .. . Seepage Trench . . . . . . m <br /> 2. Classification Land ^ Privy ,' cz <br /> Zoning Dist. Pup _ Seepage Bed <br /> 6. Use (describe exactly,�.,.J.au'c r i <br /> 3. Lot Site home, motel,etc.) FOR COMMERCIAL USE : t o <br /> ft, x ft. Plans Submitted <br /> OQ4. .. s9. ft Plant Approved . . . . . . <br />.______________________ ____________________ ___________________ <br /> Fig. A. <br /> Location of proposed structures and .Q <br /> existing structures, well, sewage sys- <br /> tems, roads, etc., should be sketched <br /> in Fig. A. Include road setback, side :✓ !�i <br /> _ and back yard dimension and location' -I a 1 <br /> 111 and setback from all bodies of water. : 11 <br /> 3s If property is located at a highway in- <br /> �I t��TTsection, show the intersecting high- ! I Q <br /> �Oy vJays and the setbacks required along A <br /> p SIJ Tar <br /> and at the intersection. <br /> PERMIT FEES J ; v <br /> Subdivision515.00 <br /> /f I goo <br /> Land Use . 1,00 <br /> Building . . . . . . . . . . . 5.00 <br /> �( < Sanitary . . . . 10.00 <br /> IJ" <br /> Well .£ <br /> Septic Tank . . /6.00 <br /> Combination Building, Sanitar , <br /> and Well . . . . . . 15.00 <br /> ' I <br /> (<c� -................._ .. ..�f. .8-.7 zJ � �� � �� L�f <br /> Signature/of Owner or Agent�/ Date / ing Qm in istrafor I <br /> Inspection Date ...Y%._�../..- �.o����............ Inspector ...... .. ..... .. ... <br /> .Remarks ............. .......... ..... . j......... ..................... ..................................<. ..........:................ <br /> c° .../I ....._.. �........_....�C3^ ....._....:......._........................:.................. .. ......... <br /> ........................ <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilitiel <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> this application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build! <br /> ing until a permit has been issued. A permit may be revoked if misrepresenta Gan of any of theinformation conveyed here <br /> with is found to exist. Changes in plans or specifications shall not be made without approval of the Zoning Adm inistratori <br /> SEWER' SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br /> -- - r <br />