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Burnett County Office of Zoning Administrator a) CD 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a P /'/ d as H <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the reL "� � /Jse co <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the law, ;in. <br /> OWNER (please print) CONTRACTOR or SU m <br /> a <br /> i ^ <br /> 3.�'..s... ......... Z <br /> ...............c -`......- ...- <br /> 2 <br /> ADDRESS ADDRESS m <br /> ADDRESS ADDRESS <br /> i S �✓ �. <br /> PHONE-` � � � �^ � � �� PHONE <br /> .............................................. <br /> PLUMBER WELL DRILLER <br /> ............ / �` �� o <br /> ADDRESS ADDRESS <br /> m G <br /> . . . ................................................................................... <br /> PHONE PHONE 6 w o Mfg !) z y <br /> r <br /> DESCRIPTION U✓ 0 0 0 <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details """"" ` o <br /> .� <br /> No. Bedrooms `�' L <br /> New Building .......... Type of Construction: """"" <,: C <br /> Addition _._ / J(/r[ ^G'�/,� �G/� Septic Tank Size Gals. <br /> X.... 5..12-4 .,�.1... .Q..................l....... . t <br /> Sanitary ......•... Size .. (r� ft. x . ft. " " <br /> g.......... <br /> Filling ...•...... Height./I........ Stories ....I......... 4a. Absorption Field Site: <br /> Moving .......... Area Soil Type ....................................Grading Slope ................. ........................ 0 <br /> ........ . <br /> Mobile Home .......... 3. Use (describe exactly, 1 family Perc. Rate ................................... <br /> Dry Well <br /> Privy .......... home,garage, motel, etc.) <br /> Well Seepage Trench .......... <br /> ....................................................Subdivision .......... Privy ......•••• <br /> .................................................... <br /> Seepage Bed ......... <br /> ---------------------------------------------------------------------- <br /> Location of proposed structures and existing structures,well,sewage systems, roads,etc., should be sketched in Fig. A. Include road �' 0- <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- o <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING L' N• <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> ---------------------------------------------------------------------- L'• <br /> 5. Lot Size: �/^ Fig. A. 6. Location: <br /> .Q.0........ ft. x .......,...... ft. — ............................... sq.ft. ............................................................................... <br /> L�Po CD <br /> o N . <br /> o <br /> `Y �' o <br /> N <br /> CD <br /> 2 :N <br /> Cnr- T W00z <br /> CD <br /> � CD <br /> m. N Q !Z — r: iZ <br /> r' w G co :� m <br /> z o o' CD `D 70 <br /> o — <br /> E» _ <br /> cn <br /> .`'/.`!.. ................. ................................. o m <br /> _ 0 <br /> Signature of Owner r Qge t Date C <br /> X 77 <br /> T <br /> Remarks ...'.1.. .................... ..........:�!�Lfl............. ................. <br /> pCD <br /> !'1kc.'!�e!re .... '�!+ I�4�n��.....� .....rb �t � ...!........ u..lc.��.. ... . c�rrti, ....v.�.. ...... <br /> "�.............. " ,1......... .. <br /> .. <br /> .......... / a...... Pef �7.:........,t�� 61 �errt•f.. �e... . <br /> Inspection Date ...7..c' �LmP� .�... 2rr� ................... 8' o C 0 o 17)in <br /> m <br /> ... ..................... .................:... ....... .. . . <br /> 0000 <br /> Zoning Ad inistrato�r� :0: o 0 0 o c/� <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolation 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 information conveyed here- <br /> with is found to exist. Changes in plans or specifications shall not be made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />