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Burnett County Office of Zoning Administrator <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT A <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 <br /> regulati sof the State of W'ssert�n. 3, <br /> ........� 4a...%. ... .u..�l...Y,O C.'4 <br /> ..... . ................................... ........................................................................................ <br /> CL <br /> OWNER (place printCONTRACTOR or SURVEYOR or AGENT <br /> ADDRESS0......../.!��..c! `:,`; .��........66`.`.�1!iRI..— DRESS............................................................................ <br /> m <br /> AQPRESS <br /> i <br /> ADDRESSDpfn <br /> WRY—, .A�fs t� I :� <br /> PHONE / .. .................... . .......................................................................................... <br /> PHONE <br /> ........... ............................................................................... <br /> PLUMBER ............. .. . . ....................................................................... ' <br /> WELL DRILLER <br /> ........................................................................................... :O <br /> ADDRESS . .......................................................................................... 0 <br /> ADDRESS <br /> ° O <br /> PHONEPHONE....................................... ....................................... 0 <br /> DESCRIPTION 4. Sanitary <br /> Facilities: ° o r <br /> 1. Work: <br /> 2. New Building Details No. Bathrooms <br /> •••.••..•. <br /> New Building ... • Ty of Construction: No. Bedrooms .......... ° <br /> Addition ,,,,, �• (�YYLC„•,,, Septic Tank Size Gals. .......... R <br /> .. r . <br /> Sanitary .......... Size ....�y.... ft. x ..1� ..... ft. .......... i <br /> Filling/Grading ,..,,,,,,, Height............. Stories ..�........... 4a. Absorption Field Site: <br /> Moving .......... Area Soil Type .................................... <br /> ........................................... ...... r <br /> - <br /> Mobil*Moblla Home .......... Slope .......................................... .. <br /> Privy .......... 3. Use (describeexactly,�1 family Perc. Rate ................................... m <br /> � <br /> Well ho drag ,motel, ) Dry Well .......... m <br /> .......... r�pp-{ppn ggggQ i� <br /> Subdivision l� �l71�1 — �� Seepage Trench .......... 0 <br /> ,Y o <br /> Camping Unit ....... . ... .. ... . ........ Privy .......... <br /> �h aoF....................... ... <br /> Seepage Bed <br /> —_ ---- <br /> — ----... � <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. L <br /> c <br /> Include road setback,side and backyard dimension and location and setback from all bodies of water. If property is located at : 0 <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 /> 0 <br /> ------------------------------------------------------- ------ '� ° <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... sq.ft. ............................................................................... <br /> c 0 <br /> N <br /> `o <br /> O_ <br /> O <br /> J <br /> ` v <br /> \ Z <br /> Sl <br /> o "U Cm nag <br /> n ma <br /> C _ <br /> '.•••.'Y ... .......... ...... .........� X p : A <br /> Signature of Qwner or Agent f ate,�..//��pp // � $ G <br /> Remarks ..I[.. iLI�.Q.Y.l..... .....PXJ.,it-hn.. .....J. x.t ./.4 SdCA'.!..4.f. '."U... !r.'.`.....�.. �xrf -n: <br /> a <br /> r //�� �.............. � .. T <br /> 11�..e4��......a......... <br /> l..�f..X....Jk�......ad. �l.:ba�-............................................................................... � N <br /> ......................................................................................................... <br /> . .. ............ . ........... <br /> Inspection Date ....................................... ! ,.....7.C�!fl.� ((./, ,�,.,L J.... aOon <br /> mZoningin�s ator y <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities before constru <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. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />