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Burnett County Office of Zoning Administrator �' c <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 <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the £ <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regu{��tition�sso�f the State of isconrsiinn.. R 3' a <br /> ....�.1..�: .•.J N.C.'5........... Q...'..:.1.7. D.. ................. . . . .. . 9�. ... ............ ............... ............................ m <br /> OWNER (please print CONTRACTOR URVEVOR or AGENT .. <br /> TU <br /> --ff- s <br /> ./...7 ............f..�..A.�.S..�?........�4.w . ............. .......... ........................................... .................. <br /> .. .......................... [�. <br /> ADORES ADDRE __ = °`f 41`0 <br /> .........5..4Iz p..... ....................... I.. .:...s.Sia ... .............. :.. 1 � ' <br /> ................ ............... 1 <br /> ADDRESS AD RESS - :� <br /> ....................�.�..v!.�.�..��...!�........7............... �� <br /> ...........................�.............................................................. .P ............................................................. <br /> ONE <br /> PHONE <br /> .. .................................................. � .Kra ..T....... ..................... <br /> PLU eER WEL DRILLER <br /> ........................................................................................... . ...........................::—............................:;........................... <br /> O <br /> ADDRESS ADDRESSC <br /> 0 <br /> t.�. 1ac. ..SJr`n <br /> PHONE . " . '- na0 PHONE Z v. r <br /> DESCRIPTION M c4. Sanitary Facilities: ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms o <br /> Haw awldmp T e Construction: No. Bedrooms ..�:.... ;�.. <br /> ... YP <br /> Addition I.- yw•� �r Septic Tank Size Gals. ./.,.,.-./.r.. . 7 <br /> Sanitary ... Size ..3. ... ft. x ..a+.Y...... ft. P•U•�••• <br /> FIIIIngfGrading .... 4a. Absorption Field Site: <br /> i� <br /> Height............. Stories ............... <br /> Moving .......... Area ......................................... . Soil Type .................................... i <br /> Mobile Home Slope .......................................... v <br /> Privy .......... 3. Use (describe exact) , 1 -family Perc. Rate ................................... . <br /> Well .......... home,garage,motel, Dry Well .......... <br /> Subdivision Seepage Trench o <br /> ,,,,,,,,,, •• ••••• • - <br /> .................................................... Privy <br /> Camping Unit ••...••... <br /> ......... .................................................... �` �,c1 <br /> Seepage Bed �$.Xyu :C k <br /> ---------------------------------------------------------------------- L e <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 located at W <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. :� o <br /> ---------------------------------- — <br /> --------------- ------ o <br /> 5. Lot Size: Fig. A. 6. Location: (),) <br /> ...... .... ft. ft. - ............................... sq.ft. <br /> CT � <br /> N O <br /> o :�0 <br /> •, <br /> T .� <br /> Z <br /> O <br /> D <br /> a <br /> s`O� fi m <br /> W <br /> M co Mtn r- D co 03 <br /> o nv � <br /> < > > o S. E. rn <br /> LD. ma,c - amany <br /> vp< mCy -M5 <br /> N 06 ,6 <br /> rZ <br /> : :Signa re ofgent Date <br /> 9 <br /> .............. rn <br /> Remarks m ' y <br /> N <br /> O . O <br /> .................................................................................................... ( .. ....................................... <br /> . . . . ......................r........................... . <br /> Kv-�n Inspection Date ....................................... ... Zoniitor o o <br /> $ <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 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 specifications shall not be <br /> made without approval of the Zoning Administrator. ���}y <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE�J APPROVED. <br />