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Burdett County Office of Zoning Administirg for 1G' 7 4�g <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3• 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the n � <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws nd <br /> regulations of the State of W opsin. — <br /> St ��.,......R.:.. m� Qn........................... ........................rs.>~.r.r.......................................... ...... !��\ <br /> OWNER (pleaseprin CONTRACTOR or SURVEYOR or AGENT <br /> ........................................ ................ <br /> ... <br /> RR.... ..,..... 7.a` ...... p ut Z s <br /> ..................................................................... <br /> A KESS ADDRESS <br /> . .. .. . ...... .... ................................. ..................................................................................... ...... <br /> ADDRESS �^ •61 <br /> ADDRESS i <br /> ............ . ........................................... <br /> .................................................................................... ...... <br /> PHONE <br /> sPrNE <br /> n.. �o.p... .ga .................................................... <br /> 1O .n.. e ecrb F................................... ...... <br /> PLUMBER WEL RILL R ' <br /> i <br /> ..... .!.L..f... 1.................................. ...... <br /> . <br /> ADDRESS A...DDR E S S m' C) i•0 <br /> n < .� <br /> O . <br /> ........................................................................................... . . ........................................................................... ...... Z . <br /> PHONE PHONE...... .. .h <br /> r '4 <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° ',�• <br /> No. Bathrooms I - <br /> 1. Work: 2. New Building Details .. "'•••• C? c <br /> Now Building No. Bedrooms .... <br /> ,. .... Type of„�onstruction: R <br /> Addition . r G,w,.--` Septic Tank Size Gals. <br /> ..•.. .. ....... _ <br /> Sanitary .. . Size ..4.Q... ft. <br /> •.X <br /> FIIIInglGradlnq Height............. Stories ..... ........ 4a. Absorption Field Site: i <br /> Moving .......... Area Soil Type ....................... .... ....... r— i <br /> .................................... ...... ° <br /> Mobile Home Slope .................................. ....... v <br /> .......... <br /> Privy ,,........ 3. Use (describe exactly,'1 -family <br /> Perc. Rate ........................... ....... m ,: <br /> Dry Well iC <br /> AVerr-- !{a,� home, rages motel etc.) .q 11 1 Seepage Trench 0 <br /> ....f.'.. ..A!�:1.t.... ...... 't.!YM.�........ Privy <br /> Camping Unit " <br /> .......... ........................ ................. ......... Seepage Bed <br /> --------------------------- ---------------------------------------- -- ` ,�, � <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fill. A. <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is local d at <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersec ion. l.N <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o' <br /> _ ______________________________________ __ <br /> 5. Lot Size: p Fig. A. 6. Locaat'ion: f <br /> ................ ft. x .............. ft. — sq. ft. N..r;L a.F.. .�`{....QY' .Sec....Sf..�. ..^.' <br /> � land ►�ns�. ;P <br /> a <br /> i <br /> flrc��i e.l� °moi O <br /> S <br /> ® " : <br /> ° <br /> 1 7C/ <br /> O <br /> Z <br /> O <br /> v <br /> m <br /> �i. <br /> X in v EnrD W coy <br /> »cr n m <br /> m No. m <br /> c <br /> C 9 <br /> 0 p O , > ' <br /> o c = m <br /> a � 0 <br /> --.. .... ...... x o <br /> onatu, <br /> of Owner or Agent Date 8 <br /> Remarks m y <br /> o . o <br /> ........................................................................................................... ....... ................. 8 <br /> Inspection Date ....................................... ...... . - ... , : v, N (T O O N m <br /> ............. . .(S.11e...y..`..... .. ............... . o <br /> Zonin Administrator 8 8 8 8 0 8 Vl <br /> NOTE: A preliminary site inspection must be made and site proval granted on all structures involving sanitary fa ilities before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this appl cation 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 bee i issued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or 3pecifications shall not be <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND AP ROVED. <br />