Laserfiche WebLink
Ef'r'! <br /> Burnett County Office of Zoning Administ ator art 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. <br /> o <br /> TO THE ZONING ADMINISTRATOR'. The undersigned hereby makes application for a Permit for the work described and located as 0 <br /> shown herein.eSanitation <br /> aThe <br /> at on Cos' es that all work shall be County <br /> in with thews and re of the Burnett County Le d Use c <br /> Ordinance, SanitaY de, and�wCl with l�o t-he�p�pl b���ty Ordinances and the laws and re ulatl Is onset o_ i i <br /> undersigned are T ed <br /> g ons of the State of W <br /> 'a <br /> d O <br /> y f <br /> ..W N E . . ... ..... .. ................. m <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT m �A n <br /> .......1,3.. .$.........11.1.11—.f. .V e................................... <br /> ................................................................................. ......... <br /> ADDRESS ,,n ADDRESS <br /> 117.� .. .o.R.t.......�:.r.N........7.Sos5.... <br /> . ...... . ....................................................................... ......... <br /> ADDRESS <br /> F ^^ LLII Op ¢ Q ADDRESS <br /> II. G <br /> t .�..d..'...�1 .1. .I.T.Q..L..A. ................................... . ...................................................................... ......... <br /> PHONE PHONE <br /> PLUMBER WELL DRILLER <br /> ................................................................. ......................... ADD. . SS.. :O <br /> ADDRESS . . . ...... .................................................................... ......... <br /> RE <br /> n O � <br /> ............. . . . .................................................................... . . . ............................................................................ ......... _. 7c <br /> PHONE PHONE Z ? <br /> DESCRIPTION 4. Sanitary Facilities: P o IY7L0— <br /> 1. Work: 2. New Building Details No. Bathrooms ......... <br /> v <br /> New building .......,,, Type of Construction: No. Bedrooms ......... <br /> 0 <br /> Addition Septic Tank Size Gals. ......... <br /> Sanitary .......... Size ........ ..... ft. x ...�.... ft. ......... <br /> Filling/Grading Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area Soil Type .......................... ......... r <br /> Mobile Home ........................................... Slope ................................ <br /> Priv Pere. Rate ......................... ......... <br /> Y ....x. 3. Use (describe exactly, 1 -family Dry Well IU\_I <br /> Well ....... ho arage, motel, etc.) •• <br /> Subdivision TIE. Seepage Trench ........ <br /> ................. ...... <br /> Camping Unit Privy ......... N <br /> ______ Seepage Bed ....... <br /> J(Y`) <br /> Location of proposed structures and existing structures, wen,sewage systems, roads, etc-, should be sketched in Fig. A. Inc Lice road <br /> setback, side and back yard dlrnensien and location and setback from all bodies of water. If property S located at a highway inter <br /> section, show the intersecting highways and the setbacks required along them and at the intersection_ CLEARLY LABEL EXISTING = <br /> a <br /> STRUCTURES AND PROPOSED STRUCTU RFS AND ADDITIONS. o <br /> 5. Lot Size: Fig. A. 6. Location: O <br /> ....III ft. x ..cA S.. ft. . ............................... sq. ft. ' E <br /> at <br /> IN <br /> 0 <br /> o <br /> y o <br /> 3v `z <br /> HS <br /> z <br /> 0 <br /> aao <br /> V <br /> n r m w Z <br /> rp C j C C N <br /> y C � <br /> Z o 11111 <br /> o a <br /> rin <br /> nm <br /> �D <br /> .� �.r.. <br /> Signature of Owner or Agent Date <br /> X �o <br /> Remarks ......................................................................................................................................................................... m m <br /> v <br /> ..................................................................................................... .... ..................... ... .... ............................... <br /> II <br /> Inspection Date ....................................... .. ... ... . . :... .. .. .... '` � H o N m <br /> M <br /> r <br /> Zoning Admini or 818 8 o o to <br /> �' ���/// <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilitioc <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must he attached to <br /> this application before a permit will be issued. Do not purchase or install a septic tank, do any plu bing Or start any bulld- <br /> ing until a permit has been issued. A permit may be revoked if misrepresentation of any of the Inf rmation conveyed here <br /> with is found to exist. Changes in plans or specifications shall not b, made without approval of the Zoning Administrator . <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE ND APPROVED. <br />