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Burnett County Office of Zoning Administri itor �' c <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT3 <br /> d <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and �2 0 <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the 7 <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 p <br /> regulations of the State of onsin. „ n , <br /> C° <br /> ................I....... 4. � ....................... ...................... '... sr. .................. ...... F $� <br /> OWNER Ipleas print) CONTRACTOR Or�VEYOR or AGENT : \ <br /> ....1..M..�i. .. ... C:r. ............................ <br /> o. <br /> ADpr:.W.s.l. -? .. ADDRESS <br /> ADDRESS .... .ADDRESS..................................................................... ...... <br /> 03] <br /> P.. EE . ........ �......... <br /> ......................................................................... <br /> .... <br /> PHONE PHONE <br /> ticE <br /> I ,JGO <br /> BER) � ........... ......................... ...................... ..................................................................................... ...... <br /> WELL DRILLER <br /> � <br /> .................................................................................... ...:., <br /> ADDRESS ADDRESS r�, a 0 Z <br /> ................... . . . . . . . .................................."".................. . . . . ............................................................................ ...... ` `�� p � <br /> PHONE PHONE.. `\�?�) 2 <br /> DESCRIPTION 4. Sanitary Facilities: v _ o <br /> 1. Work: No. Bedhooms - `3.... 0 <br /> New Building 2. New Building Details L e '---i- <br /> o ... Type of Construe ' n: r $ <br /> 9 <br /> Addition •, ,,, 1� 'riM Septic Tank Size Gals. ...... - <br /> . ......... ....... . ....... � <br /> Sanitary .yx.... Size ... .`�.... ft. x ...3..�.. ft. ....... 1J� :yam- <br /> Fillinglarading .......... Height............ Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area ....:7 ...... .... T.......... Soil Type ............................ . ... r <br /> o <br /> Mobile Home .......... 3. Use (describe exactly -family Slope .................................. ....... : » •�j �„— <br /> J <br /> Privy Perc. Rate ........................... ...... <br /> .......... <br /> Well .......... home,garage,motel, etc.) Dry Well .. ....... m i <br /> subdivisionL /,� % Seepage Trench z <br /> Camping Unit .......... Privy .... .. <br /> ............... .................................... <br /> Seepage Bed r . .� � <br /> ------------------------------------------------------------------- -- <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. C :m <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is local d at 'C <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersect on. W `— <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. — o <br /> 5. Lot Size: Fig. A. 6. Location: :`j 1 <br /> ................ It. x .............. ft. — sq. ft. <br /> � n <br /> NN <br /> O 7 <br /> 7 <br /> O <br /> O O <br /> y <br /> � D <br /> e T <br /> r45 l� ua `I --� o <br /> 1 <br /> In <br /> b' <br /> Sf . <br /> � N > > <br /> Zoo : ° 0 >Q � <br /> ..................... + ..................................... x n : m <br /> Signature of Own gent Date o <br /> T: y <br /> v, <br /> ui <br /> Inspection Date .. ✓ P •� rT.q^ N N o 0 oNi m <br /> pe ....................................... /CCQA!...........a. ... m <br /> Zoning Admin, ator $ $ $ $ $ $ N <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this application before a permit will <br /> be issued. Do not purchase or install a septic tank, do any plumbing or start any building until a permit has been issued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or specifications shall not be <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />