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Burnett County Office of Zoning Administrator <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3• <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described land '� 0'� � \ <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the n W <br /> ( pp County Ordinances and the laws land 3 '• <br /> Burnett Count Land Use Ordinance, <br /> 3 p, i <br /> OWNER ple SpT^tCRANBERRIES C.KiRONLUND)tn all otnerAa.M.EA�2TH`:' AKS CONST. IN ,"», <br /> ance, Sanitation <br /> regulations <br /> P <br /> 1. .. ..... .. . ..... ........................................... ...... :— <br /> CONTRACTOR or SURVEYOR or AGENT <br /> STARAT BOX 4. 3 .. .. ............................... ............ . . ...................................................................: 'a E <br /> � .. .... . �`.. .. .. d <br /> P,O.Box <br /> ADDRESS ADDRESS � <br /> SPOON}3 t iq 4801 ..... SPOON�R. VZL 4801............................ <br /> ADDRESS ADDRESS <br /> .......................... ........................63.5-7595.....................................{....... <br /> PHONE....................... PHONE <br /> J <br /> A2LYN J. HELMELRILLER ....................................................... t <br /> PLUMBER WL DRID <br /> ... o <br /> ADDRESS ADDRESS <br /> CC C(�C n O <br /> ..........63J. 7.595........................................................... » <. <br /> PHONE PHONE Z N <br /> DESCRIPTION 4. Sanitary Facilities: ` 0 ° <br /> 1. Work: 2. New BuildingDetails No. Bathrooms .. .3...Bedrooms o <br /> — <br /> Nsw Building ,,,,,,--,- Type of Construction: No. <br /> Septic Tank Size Gals. <br /> Addition .......... ................................................. . < :f <br /> Sanitary .......... Size .............. ft. x .............. ft. <br /> .. ....... <br /> Fillingf Grading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area Soil Type ........................6. ...... o <br /> Mobile Nome Slope .............................. ....... » <br /> .......... <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ............... ........ ....... <br /> n <br /> Well ,......... home, age,motel, etc.) Dry Well ..... a <br /> �—FAMILY Seepage Trench .......... z <br /> Camps Subdivtalon .......... ° <br /> Camping Unit Privy .......... : <br /> Seepage Bed .. .— S Q: FT: i n <br /> Location of proposed structures and existing structures well, sewage systems, roads, etc., should be sketched-in Ft . A. ,tr g tv 1 <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property/is localed at - <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersec ion. <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. —_ <br /> 5. Lot Size: Fig. A. 6. LocationFI �� o <br /> -------------------------- ----------------- <br /> ................ ft. x .............. ft. — ............................... sq.ft. ................................................................... ........ <br /> r <br /> SEE ATACHED SHEET <br /> 0 <br /> 0 <br /> i <br /> Q� Z <br /> 37 <br /> J <br /> b <br /> N <br /> co <br /> 71 d N n W tD a <br /> m Nn� '— nm nag <br /> Z�o m Ci <br /> , Dn <br /> ° <br /> o a : <br /> n 0 : O <br /> MAY 23 ,1988 x r, : o <br /> ...... .. .... ......... . ............................ p <br /> C <br /> Signature Ow or Agent Date $ <br /> Remarks ................................................................................................................... ......... I' m � am <br /> �• <br /> ................................................................................................................................................................................ J ~ N <br /> .....................................................................................................?roval <br /> ............... ............................ <br /> y)..... .. N : u m <br /> IF 1� .. .. (J� fT N O O V� <br /> Inspection Date ....................................... .... .......... . . .. ... . .......... (P. o o . m <br /> ZoningAdministra r dy'y✓1 �8 88 S 0 8 U) <br /> NOTE: A preliminary site inspection must be made and site alpranted on all structures involving sanitary f4cilities 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 />