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0-'�2c yam . <br /> BunteCt County Office of Zoning Administrator �' o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d — <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and M (1�' <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the X <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances aij(j4hglsws and 3 i3 0 <br /> re tions f the Sta f Wii pns�in. GG�4ve (( » $ <br /> 4�.. ............ A !� �'.......................... ........................................................................................... <br /> OWNER (1 4ease print) pr CONTRACTOR or SURVEYOR or AGENT <br /> .1..2J...........n.......................................{.�..... . ..................� ............................................................................................ o <br /> AADDRESS <br /> ....N••••• •.t..F.C ...... ...'••\. ...... .5~ .L ............................................................................. <br /> d <br /> AA <br /> ADDRESS ADDRESS <br /> PHQ..I.�.E............................C................................................... .PHONE................................................................................ t �� <br /> J/'��.' ...... ................................................................. ............................................................................................ <br /> PLUMBE� WELL DRILLER <br /> O <br /> ADDRESS ADDRESS <br /> n o <br /> . ....................................................................................... . .PHON.. E. .......................... <br /> .......................................................... Z N <br /> PHONE <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms .. c <br /> New Building ..•....... Type of Con ua, No. Bedrooms <br /> Addition ,�,,,, Septic Tank Size Gals. ...... ... p <br /> Sanitary Size .............. ft. x .............. ft <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: ` <br /> Moving .......... Area Soil Type .................................... i <br /> Mobile Home Slope .......................................... 0 c <br /> .......... <br /> Privy .......... 3. Use (describe exactly,*1 •family Perc. Rate ................................... <br /> Welt ,,,,,,,,,. home,garage,motel, etc.) Dry Well .......... n! w <br /> Seepage Trench Z <br /> Subdivision .......... ° <br /> Camping Unit .......... .................................................... Privy y L <br /> Seepage Bed f O..x��. <br /> ---------------------------------------------------------------------- rn <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. ^, ° <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is located at <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersection. YJ N <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. 0 <br /> ---------------------- ------------------- <br /> '--- <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — sq.ft. ...................................................... :- <br /> IN c O <br /> O � <br /> \} - <br /> '7- <br /> lt� , <br /> T <br /> s � <br /> t <br /> Z <br /> 0 <br /> p <br /> . m <br /> D (n -o U) r­ D rp W -0 <br /> Im <br /> 0 o o <br /> �.O m <br /> Z � D � 1 <br /> o N N n <br /> g n : m <br /> L <br /> Signature of wner or Agent Date ' $ <br /> Remarks . .....1.... .0U.... .L.......................................................................................................................... a : <br /> .......................................................................................................... . ............. ........... <br /> � - 2 Y- �, • N ooF' m <br /> Inspection Date ............................... ..... . ..... . . g . . <br /> Zonin 'Admin rator. g $ 0 8 U) <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 />