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Burnett County Office of Zoning Administrator j -- o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d rt. M <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and to abed as •� <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County L r Use <br /> Ordinance, <br /> eitaiion Code, and w <br /> lea e ' CONTRACTOR or SUf�VEVORor ' . 3 0_ i <br /> O <br /> with all other applicable County Ordinances and the laws and regulations of the State of Wonsi n <br /> a <br /> O �A y E r 1. ,�—... ........ ........ <br /> OW ( p ) AGENT a m <br /> r... ...a..... ............................................... , <br /> . . . . . ...................................................................... ...... <br /> ADDRESS ADDRESS <br /> 91 <br /> ....r................................................................... ............................................................ ........ � <br /> ADDRESS ADDRESS <br /> PHONEPHONE <br /> . ............................................................................... <br /> PLUMBER WELL DRILLER <br /> O <br /> ADDRESS ADDRESS <br /> n 0 <br /> ........................................................................................... ................................................... ....................................... o' ,`.• <br /> PHONE PHONE Z �, r— <br /> DESCRIPTION 4. SanitaryFacilities: ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms ........ o <br /> New Building ,,,,.,.,,, Type of Construction: No. Bedrooms .......... <br /> Addition ....XSeptic Tank Size Gals. .......... .� c <br /> Sanitary .......... Size .... P..... ft. x .a'S!Y'ft. .......... i <br /> Filling/Grading g ' 4a. Absorption Field Site: <br /> .......... Height ......%......... . <br /> Moving .......... Area Soil Type ........................ ........... o <br /> Mobile Home .......... Slope .............................. ........... ,+ <br /> Privy ,,........ 3. Use (describe exactly, 1 -family Perc. Rate ....................... ........... <br /> well .......... home,garage, motel, etc.) Dry Well .......... i <br /> Subdivision .......... �'0 dJ/q Seepage Trench .......... <br /> Camping Unit .......... Privy .......... <br /> .................................................... <br /> Seepage Bed .......... <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc.,should be sketched in Fig A_ Incl de road <br /> setback, side and back yard dimension and location and setback from all bodies of water. If properly is located at a highway Inter- a <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EX ISTING <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. — i o <br /> __________________________________ ______________________________ _____ <br /> 5. Lot Size: Fig. A. 6. Location: O i <br /> ................ ft. x .............. ft. . ............................... sq.ft. .................................................................. ............ <br /> Co <br /> SAKE $ N s <br /> O <br /> 3 <br /> nQ <br /> I — <br /> Il n11vil <br /> lJ� <br /> h <br /> _ \ `\ W �. �) � on r 9 rn m Z <br /> l n to m m � m <br /> ka <br /> 1 IAZ o �. <br /> `fl4 41 <br /> y n <br /> .... .. ° <br /> Signature of Owner o Agent Date _ <br /> X <br /> ?I .. <br /> .: <br /> r <br /> Remarks ............................................ ........................................... ........... ............................ . ........ ......... ; <br /> .. ....:_CL..�... ...... . .C.. ..................... ..... .... ......... ....... <br /> II <br /> .......................................................................................:................ .. ....................... .. <br /> ...... <br /> Inspection Date ....................................... ... .. .... �,.... ... .. .... a o o r <br /> dm� 'l r <br /> Zoning Administrat r g g o 0 o C <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures�invo lvng sanitary facil -a <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolate n 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 misrepresentation of any of the formation conveyed here- <br /> with is found to exist. Changes in plans or specifications shall not be made without approval of the Zoning Adminlstratoi. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFIC AND APPROVED. <br />