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Burnett County Office of Zoning Administrator . � A <br /> ato �z <br /> d�o a <br /> APPLICATION FOR SANITARY — LAND•USE"— BUILDING PERMIT <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a u o <br /> Permit for the work described and located as shown herein. The undersigned agrees that all o N <br /> work shall be done in accordance with the requirements:of the County Zoning Ordinance, ,r <br /> Sanitation Code, and with all other applicahle County Ordinances and the laws and regu- -c i0 <br /> Iii of the State of(�isc/gnsin: O <br /> Owner or Agent (please print) Contractor or Surveyor :T <br /> q _ <br /> Address Address <br /> IIAf �..�. ✓Mrn �t _ SJ43 I_ <br /> - . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> Phone Phone <br /> Plumber Well Driller \r : <br /> Address . �. . . . . . . ^ . . . . . . . . . .... Address .`. . . . . . . . . . . . . . . . . ... . . . . . . . . . . \ ;` �l Ll <br /> aJ : ( <br /> o o <br /> m o v <br /> Phone Phone ��� � M r it <br /> A ° 7 <br /> 0 <br /> DESCRIPTION 4. Building Details .7. Sanitary Facilities <br /> Type 4ion of Conpthr 1�� I^a' No. Bathrooms . . . . . o z t <br /> 1. Work �:� r /- Dishwasher . . o �. <br /> New Building . . . . . . Size . .�!.-- II. x . ,W. `� it. Garbage Grinder . . .. . 'Q �, .� IL <br /> Addition _ . . . . / Height . . . . . Stories . . . . . . Autem. Laundry — V <br /> Sanitary . .4� Area . . . . . . . . . . . . . . . . . No. Bedrooms . . .L . . <br /> Alterations . . . . . . Waste Disposal System. <br /> J <br /> Moving . . . . . . S. Permits Required Septic Tank Site Gals. <br /> z <br /> Wrecking . . . . . . Subdivision . . Absorption Field aSite <br />' Mobile Home Sanitary Soil Type <br /> Privy - . . . . rBuildiny Some . . I �.� w <br /> Well Well Peres Rate —,X <br /> h+r_ .':r. . .S. . . . �A <br /> Subdivision . . . . . . Other (Specify) - . . . . . Dry Well . . . . . . <br /> . . . . . . .� <br /> Conditional ill m rn <br /> . . . . . . Seepage Trench <br /> c <br /> 2. Classification Land . . . . . . Privy . . . . . . i a <br /> Zoning Dist. . . . Seepage Bed I a K _ ? a. o <br /> 6. Use (describe exactly(1 -fam. <br /> 3. Lot Size home, motel,etc.) FOR COMMERCIAL USE sa <br /> ft. x -. . . ft- Plans Submitted t <br /> ft. - Plans Approved . . . . . �\ <br /> . --- <br /> Fig. A. Location of proposed structures and ` I <br /> existing structures, well, sewage sy s- :e :Vo <br /> hems, roads, etc., should tie sketched <br /> b <br /> ./— (� In Fig. A. Include road setback, side <br /> and back yard dimension and location <br /> and setback from all bodies oI water. <br /> If property is located at a highway in <br /> �r tersection, show the Intersecting high- <br /> ways and the setbacks required along <br /> �A a 1\ t rm and at the intersection. <br /> V A <br /> i }cor PERMIT FEES �1 <br /> S division . . . . . . . $15.00- <br /> Land Use . . . 1.00 <br /> S �Co Building . .. . . . . . . . . 5 0 iW <br /> Sanitary . . . . . . . . 10.00 <br /> Well . . . . . - . . .00- <br /> Septic Tank . . .. . . /0.00 <br /> Combination Building, Sanitary <br /> and Well . . . . . 15.00 <br /> I <br /> Signature of O e ort�Agent Date / Zoni Ad'n stratorn I <br /> Inspection Date ...[... .{.` f. Inspector �ti r...�! '..-. ...... <br /> Remarks . .. .. .. ..._... . .... ._.... ... .. ...... . <br /> bk �._..........Ca� �t .... ............. ................ <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—i <br /> this application before a permit will be issued. Do not purchase or nostril 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 />