Laserfiche WebLink
10 <br /> Burnett County Office of Zoning Administri for W 'gg� <br /> APPLICATION FOR SANITARY - LAND USE - BUILDING PERMIT 3 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and Q + <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements o the .8 <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 iUQ <br /> reg u let ions of eStateyFWi consi n, n o. <br /> ../�..f..i�;,�u-E%...�../ ��1� .�......... ..........................s:��t...................................... ...... a j <br /> OW (pies"print) CONTRACTOR or SURVEYOR or AGENT <br /> ..1....... o� <br /> .................................. ............ . ................................................................... .... <br /> ADDR55f ADDRESS '7 <br /> .. 'f .c� .................................................................................... ...... <br /> ADDRESS ADDRESS :� <br /> ............................... ..( ..- / .......... .................................................................................... ....... <br /> PHONE. ............................................................................... PHONE ( <br /> . . . ....... .. . . ............................................................... ....... . <br /> PLUMBER WELL DRILLER <br /> v ' <br /> ADDRESS ADDRESS n C <br /> 4 1 <br /> ........................................................................................... .................................................................................... ....... O 1 <br /> PHONE PHONE Z N <br /> DESCRIPTION 4. Sanitary F cilities: P o E(b <br /> 1. Work: 2. New Building Details IN Bathro ms e -,' <br /> New Building Type of�r°nstruction: No. Bedroo s .. ....... <br /> Addition ........... "x ................ Septic Tank ize GaVf. .. ....... ; <br /> Sanitary Size ..aS.l .t. ff. x .....lA... ft. .. ....... . <br /> Filling/Grading .......... Height......... Stories .....!�....... 4a. Absorption Fi Id Site: <br /> Moving .......... Area ........................................... Soil Type ..... ............. ....... � r <br /> Mobile Home .......... Slope ................. ................ ....... i <br /> Privy .......... 3. Use (describe exactly,-1 -family Perc. Rat ........... ............. ....... <br /> Well home,garage,motel, etc.) Dry Wall .... <br /> Subdivision Se age Trench o <br /> .......... <br /> Camping Unit ' <br /> t �J <br /> .................................................... rivy I`n <br /> Seepage Bed .. ....... <br /> ------------------------------------------------------------------- -- N Y <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fill. A. <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is located atv g <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersec ion. kc <br /> N <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. _ o ;Z <br /> ___________________________________________________________________ IT :_ <br /> 5. Lot Size: Fig. A. 6. Location: C> i <br /> ................ ft. x .............. ft. — ............................... sq. ft. ..................................................... ........ <br /> ..a. . ...... <br /> o <br /> GV <br /> 0 <br /> �0 o <br /> 7r7� <br /> 5 <br /> I „ iL. <br /> Zz <br /> P <br /> n <br /> 0 " <br /> /L <br /> 1 a c -0 m r n cm c <br /> 0 <br /> � _ _ m <br /> O G K C o n 3 <br /> N <br /> /G' � c o 2 = : m <br /> _ c <br /> 01 <br /> rn <br /> ....... . a . <br /> ign lure of Ow er or Agent Date 8 <br /> Rem rks <br /> m �• <br /> N <br /> O : S <br /> .. ............................................................................I........................... ... ..... .. ................... n O <br /> Inspection Date ....................................... ... .... . . . .......... N N O <br /> Zonin Administrator 8 8 8 8 �8 Sli <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 app)cation 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 beeii issued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or 3pecifications 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 />