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Burnett County Office of Zoning Administrator rn/ ' ` 1/o - <br /> CD <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 CD� o0, <br /> °0 3 � <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a _ <br /> Permit for the work described and located as shown herein. The undersigned agrees that all o <br /> work shall be done in accordance with the requirements of the County Zoning Ordinance, <br /> Sanitation Code, and with all other applicable County Ordinances and the la <br /> ws and regu CD <br /> 0- <br /> Sanitation jt�e State of�llyspon in. � <br /> i ) a <br /> Owner or Agent (please print) Contractor or Surveyor <br /> N <br /> C <br /> CD <br /> Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> Address a / <br /> d <br /> Phone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> Phone <br /> Plumber <br /> Well Driller <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ' <br /> Address Address <br /> n o <br /> Phone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . � � •* ' <br /> Phone <br /> m y r <br /> n r, o <br /> CD <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: '° <br /> Type of Construction No. Bathrooms • • • • • . o Z oo -¢ <br /> 1. Work No. Bedrooms . . . . . . o m <br /> New Building Size . . . . . ft. x . . . . . . ft. Septic Tank Size Gals. —" <br /> Addition . . . . . . Height . . . . . Stories . . . . . . <br /> Sanitary . . . . . . Area . . . . . . . . . . . . . . . . . . . 7a.Absorption Field Site: <br /> Filling . . . . . . Soil Type . . . . . . . . . . . . . . . . . . r <br /> o <br /> Moving . . . . . . 5. Permits Required Slope . . . . . . . . . . . . . . . . . . . . <br /> r. <br /> Grading . . . . . . Subdivision X. • • Perc. Rate . . . . . . . . . . . . . . . . . <br /> Mobile Home . . . . . . Sanitary , • • • Dry Well - - <br /> CD <br /> Privy . . . . . . Building • . . • • . Seepage Trench . . CD CD <br /> Well . . . . . . Well . . . . . . Privy <br /> Subdivision )C. Other (Specify) . . . . . . Seepage Bed . . . . . . <br /> Conditional . . . . . . cn cn <br /> C CD <br /> 2. Classification Land Use . . . . . . :0 0 <br /> .Q a 0 <br /> Zoning Dist. .� ` CL o <br /> 6. Use (describe exactly, 1 -fam. <br /> 3. Lot Size home, motel,etc.) FOR COMMERCIAL USE i <br /> . . . . . . . . . ft. x . . . . . . . . ft. Plans Submitted <br /> . . . . . . . . . . . . . . . . . . sq. ft. Plans Approved <br /> ---------------------------------------------------------- <br /> Fig. A. Location of proposed structures and <br /> existing structures, well, sewage sys- ) o <br /> tems, roads, etc., should be sketched'-' ' <br /> nn in Fig. A. Include road setback, side 's <br /> �.�?•� C' and back yard dimension and location '' �` -6• <br /> and setback from all bodies of water. <br /> If property is located at a highway in- J 0(1 <br /> tersection, show the intersecting high- <br /> ways and the setbacks required along v <br /> 1 l , them and at the intersection. <br /> PERMIT FEES <br /> Subdivision . . . . . . . . <br /> Land Use . . . . . . . . . . . � <br /> Building . . . . . . . . . . . 5.00 rr, <br /> Sanitary 10.00 V <br /> Well . . . . . . . . . . . 5.00 <br /> Septic Tank . . . . . . . . . 1()00 <br /> Combination Building, Sanitary <br /> and Well . . . . . . . . 15.00 <br /> Privy . . . . . . . . . . . . 5.00 <br /> .............. ............ ..................................... �. .:�� ..7......... ... � �r �.. ... ..nf. <br /> Signature of Owner or Agent Date Z ni A inistrator <br /> InspectionDate ................................................ Inspector ................................................................................................ <br /> Remarks ............................................................................................................................................................ <br /> ................................................................................................................................................................................................ <br /> ................................................................................................................................................................................................ <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 /> Wlth 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 />