Laserfiche WebLink
�,T7��i i'-�(`;�(•�if_� . <br /> Burnett County Office of Zoning Administrator <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 1 �• 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and 0 <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the n c <br /> Burnett so the Stat Use W si e,n. Sanitation Code, and with all of applicable County Ordinances and the laws and N VIII a <br /> 1(Pl1o\' 1� Sc�e 3 <br /> A — <br /> E I..""pr'l r CONTRACTOR o r S VEYO NT <br /> . h.... ................................ t... i.. fix... r �.................................... ir <br /> RES . . .... .. ... � .AD� $ SII � � • <br /> or �� ► i.,.. . .. 8 . ; <br /> .... ..t .K ...r�.......................i.p................ e, .,......( ..........s...� ...................... <br /> ADDRESS ADDRESS <br /> ................................................. <br /> ........................................................................................... .P..H..ONE...................................... <br /> PHONE � <br /> .... ...... ............................................................................... . . . ..L..D..R...ILL.....ER....................................................................... <br /> PLUMBER WELi <br /> ........................................................................................... ............................................................................................ <br /> ADDRESS ADDRESS o' C ^1 <br /> ............. <br /> . . . ................................................................................... .PHO-H-0-NE............................................ .......................... O r <br /> r <br /> IL <br /> PHONE Z� (, <br /> DESCRIPTION 4. SanitarYFacilities: ° o » _ <br /> 1. Work: 2. New Building Details No. Bathrooms .......... I c �` <br /> New Building Type of Construction: No. Bedrooms .......... III R <br /> .......... K� <br /> AdditionSeptic Tank Size Gals. .......... <br /> .......... .................................................... <br /> Sanitary .......... Size .............. ft. x .............. ft. .......... <br /> FuungfGrading ......•... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area ........................................... Soil Type .................................... <br /> C <br /> Mobile Home .......... Slope .......................................... .. <br /> Use <br /> e exactly 1 - <br /> Privy X. ..........9....9... .... ..... .... . .. Seep Well lTrench .......... m <br /> Well 9 home,garage, motel,, etc.) Dry <br /> Subdivision <br /> ...ily Perc. Rate ................................... <br /> Camping Unit Privy .......... <br /> .......... .................................................... <br /> Seepage Bed .......... `�' E <br /> ---------------------------------------------------------------------- <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. N <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o <br /> ______________________________________________________________________ i <br /> J <br /> 5. Lot Size: Fig. A. 6. Location: D <br /> ................ ft. x .............. ft. . ............................... sq.ft. ............................................................................... <br /> s � 1 <br /> O <br /> f <br /> m <br /> Z �) <br /> a <br /> d <br /> m � mr > mm <br /> m -' am an 31 <br /> Z ° D 1 <br /> o y n <br /> n <br /> �o 2 m <br /> � 0 <br /> = c <br /> X n : m <br /> ........................................................................... ...................................... <br /> Signature of Owner or Agent Date <br /> W y . <br /> Remarks ......................................................................................................................................................................... <br /> n <br /> v <br /> ........................................................................................................................................................................................ N O <br /> Inspection Date ....................................... ....... . . . ...1.............1...4..L!!!.G(,. u, u. u, 'o o u, m <br /> 00 0 <br /> N M <br /> r ........ N CD N m <br /> Zoning Administrate o $ o o $ $ fA <br /> NOTE: A preliminary site inspection must be made and site app oval 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 specificatiorls 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 />