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Burnett County Office of Zoning Administrator L' <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 describedand <br /> o <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 and 3 r3 .— <br /> regu lat ions"a State of Al in. <br /> l.t .��...1X �u2S0..J ....... . . . . f _ <br /> n <br /> OWNER IDie grin 1 CONTRACTOR or SURVEYOR or AGENT <br /> ..' :...I.. -3°X �6 y i <br /> .............ESS ,.......... .....I. ...... ............................. ..................................................................................... ...... d <br /> ADDRESS W T SWIL <br /> ADDRESS <br /> ADDRESS ADDRESS <br /> ....... ...... <br /> ........................................................................................... . .P-H-0- .................................................................... . <br /> PHONE N <br /> ........................................................................................... . . ..L...D.....RILLER. ......................................................................... <br /> PLUMBER WELj� <br /> ADDRESS ADDRESS n 0 <br /> O O <br /> c <br /> PHONE PHONE j Z ar <br /> DESCRIPTION 4. Sanitary Facilities: I P o <br /> 1. Work: 2. New Building Details No. Bathrooms c <br /> No. Bedrooms 1 <br /> Naw Building % Type of Construettyy'ppn• 2f�G� "1•""'• i � <br /> C9'� Septic Tank Size Gals. <br /> Addition .......... ............... . r................ ....f..... ..�....... <br /> Sanitary Size ...Z .... ft. x .. .... ft. <br /> Filling/Grading .......... Height .... St ries 4a. Absorption Field Site: <br /> .1 g fir. <br /> Moving .......... Area ......Ta.!?'..Z S6l:..0 / -.......... Soil Type ............................ ....... <br /> MODIIe Home .......... $IOPe .................................. ....... o <br /> ^� <br /> Priv Perc. Rate ........................... ....... w <br /> Privy .......... 3. Use (describe exactly, 1 -family 0 <br /> Well .......— home,garage, motel,Atc.) y <br /> Or Well i <br /> Subdivision ..,....... ((i4, Seepage Trench .. ....... o <br /> A.. ................. <br /> Camping Unit .......... Privy .. ....... <br /> Seepage Bed .. ....... <br /> _- i fA <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. C <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is local d at 4 <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersection. <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. .� <br /> ___________________________ -_-_-____-_____________________ __ <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... sq.ft. 1 <br /> C7 � <br /> N p <br /> O J <br /> J n , <br /> u] SUNS <br /> abgR T <br /> �I�� s� �anance Z <br /> O <br /> p <br /> a <br /> J <br /> m <br /> M rnvmr Dm m -0 <br /> n tnp < > > o c c ur <br /> _. <br /> m enc - C a n y <br /> < d C o J J ; <br /> O fO t0 <br /> Z o > -1 <br /> O J N o <br /> n : S <br /> o 0 m <br /> K A : O <br /> Signature of Owner or Agent Date c <br /> Remarks <br /> .................................................................................................................................................................... " <br /> u <br /> o . <br /> 0 <br /> ....................................................................................................... ........ ..................... .. .... ... . o . <br /> Inspection Date ....................................... ..... . . . .. .....L. Qi. ....... ,vNi ocNn <br /> Zoning Administr� .... 8 8 8 8 0 <br /> NOTE: A preliminary site inspection must be made and site approval 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 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 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 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 />