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r: <br /> Burnett County Office of Zoning Administrator W CD o Z <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as H 0 <br /> shown{,erein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use CD <br /> - c <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations fD <br /> 4 v. r ' `� `bW0&rPJSCANNtD c 03 o <br /> ....r...!..w.......... .....$. .... ,................................................ y <br /> .... <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a J <br /> Q 7 <br /> ..... .. ...........f.3. ............................................ .. <br /> ADDRESS ADDRESS m 4 <br /> ti4.��^!?.!►A .............�y .. ............................................................................................ <br /> ADDRESS ADDRESS <br /> ............................ ............................................................. ......................................................................................... � <br /> P..RN E <br /> PHONE <br /> ..... .....`........................................................ . .. <br /> PLUMBER WELL DRILL.ER <br /> ............................................. <br /> ADDRESS ADDRESS <br /> h o <br /> P ............. :Z y. <br /> PHONE HONE 3 <br /> DESCRIPTION 0 <br /> 4. Sanitary Facilities: ° o ° e <br /> 1. Work: 2. New Building Details No. Bathrooms .... .. <br /> • o <br /> New Building .... Type onstruction: No. Bedrooms .......... m <br /> Addition „•,• •......., r,a„!^`•'t Septic Tank Size Gals. 'ry <br /> Sanitary ...• Size 4.9...... ft. x <br /> ``/l v , ; <br /> 7..... ft. <br /> Filling .•........ Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area Soil Type .................................... :� m <br /> ........................................... . . <br /> Grading Slope .......................................... ' ° <br /> Mobile Home Perc. Rate ................................... <br /> 3. Use (describe exact) -famil . <br /> Privy .......... home,garage, motel, etc.) Dry Well .......... <br /> Well Seepage Trench <br /> „••„•... :tA <br /> Subdivision Privy <br /> ................................................... :�.. <br /> Seepage Bed <br /> -- --- ----- --- ---------------------------------------- cn <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc.,should be sketched in Fig. A. Include road C r <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- _Q �' <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING ^� <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> ------------- ---------------- -- -------------------------- : Csa <br /> 5. �Q t Size: Fig. A. 6. Location:�j 3 <br /> °...7.a.... ft. x �....... ft. — ....�.-..I...l.....�..... ft. ................. ................ :N <br /> 0 <br /> o <br /> l <br /> _,4," N <br /> 0 <br /> VC <br /> CD <br /> z <br /> 0 <br /> d <br /> m <br /> � � � <br /> a <' m <br /> fD ry. aa < — ' <br /> •a cn < C : 61 v, <br /> Z 0 O m T- <br /> o <br /> to <br /> V 0 <br /> ,A r 7 <br /> .............1�4�-�t , �v`�... G...... �,� �� p <br /> Signature of Owner or Agent ate <br /> Remark `...�..... .. y4�c-....p ..../9 ...................................................... m X 70 <br /> - <br /> m <br /> CD <br /> CD <br /> v <br /> .......... . ... ..... ........................................... . . . <br /> ... . . . . . . . .......... <br /> . .. .. ..................... ... ... .. ..... .. .. .... <br /> .......................ram... . ...�. ...... _ ................................. <br /> /� ,/ .... .... .. .. ........................................ <br /> Inspection Date .!�•. °` `� — . f � <br /> 9 <br /> v ): 000000m <br /> Zoning A ministrator 4 0 0 0 0 0 0 (n <br /> VOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> )efore construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> :his application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build- <br /> ng until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> vith 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 />