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Burnett County Office of Zoning Administrator o z <br /> a 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 4. 3 <br /> 00 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a •_ <br /> Permit for the work described and located as shown herein. The undersigned agrees that all r :� <br /> work shall be done in accordance with the requirements of the County Zoning Ordinance, <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- °- <br /> lati ns of the State of W' con i f p <br /> a >U <br /> jj ( 3 �Q F <br /> ner orwjent (Please print) tractor or Sury or <br /> AA . . . . . <br /> Address dd re. a V • <br /> 6/ �J <br /> We <br /> Phone .Phone <br /> E5,4 /3 8 <br /> . . . . . . . . . . . . . . . . . . <br /> Plumber Well Driller <br /> . . .ress e'ss . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> AddAddress m <br /> n o <br /> . . . . . . . . . . . . . . . <br /> 0 - <br /> . . . . . . . . . . . . . � r <br /> Phone Phone 0 <br /> m 0 <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: -o <br /> Type of onstr coon No. Bathrooms ' ' ' ' ' ' o o <br /> 1. Work ,/ . . ./fz 11' !�' - No. Bedrooms . . . . . . - <br /> New Building . X. . Size .X� ft. x .�7. ft. Septic Tank Size Gals. . . . . . . ? .� <br /> Addition . . . . . . Height . $./ Stories . . . . . . . . . . . <br /> Sanitary . . . . . . Area <br /> 7a.Absorption Field Site: <br /> . .�,7�,. <br /> Filling . . . . . . Soil Type . . . . . . . . . . . . . . . . . . :,ZN`1 <br /> � � � � � • � • • • • • • � � � � � � � o <br /> Slope <br /> Moving . . . . . . 5. Permits Required <br /> Grading . . . . . . Subdivision . . . . . . Pere. Rate17N <br /> . . . . . . . . . . . . . . . . . <br /> Mobile Home . . . . . . SanitaryDry Well . . . . . . <br /> . . . . . . <br /> Privy . . . . . . Building . . . . Seepage Trench <br /> Well . . . . . . Well Privy . . . . . . s <br /> Subdivision . . . . . . Other (Specify) . . . . . . Seepage Bed . . . . . . o <br /> U` <br /> Conditional . . . . . . ks c <br /> 10 o <br /> 2. Classification c) Land Use . . . . . . n. <br /> Zoning Dist. ;i 0 <br /> Fj 6. Use (describe exactly, 1 -fam. <br /> 0 :p <br /> 3. Lot Size home, motel, etc.) FOR COMMERCIAL USE 144 _ <br /> ft. x ft. Plans Submitted . . . . . . ? <br /> ;t3Q�0.4.10 . . . . . . sq. ft. �O_Ytlg �- Plans Approved . . . . . . <br />-----------------------Fig. A. ----_ Location of <br /> proposed structures and <br /> / u k existing structures, well, sewage sys- <br /> G- tems, roads, etc., should be sketched _ <br /> in Fig. A. Include road setback, side <br /> and back yard dimension and location <br /> and setback from all bodies of water. <br /> If property is located at a highway in- •S <br /> tersection, show the intersecting high- :A <br /> ways and the setbacks required along <br /> them and at the intersection. <br /> PERMIT FEES <br /> Subdivision . . . . . . . . . $15.00 t° <br /> Gz,� Land Use . 1.00 :& <br /> ocT uildin ,25.00 <br /> 4 a i ary . . . . . . . . . . . 10.00 <br /> Well . . . 5.00 <br /> Septic Tank . . . . . . . . . 10.00 <br /> Combination Building, Sanitary <br /> I L and Well . . . . . . . . 15.00 <br /> If,0 i Privy . . . . . . . . . . . . 5.00 <br /> � � <br /> .... . .. ..... . .... .....:...-� ................ <br /> I a ur Ow r Agent Date Zoning Administrator mac✓ <br /> InspectionDate ................................................ Inspector ................................................................................................ <br /> Remarks ............................................................................................................................................................ <br /> ................................................................................................................................................................................................ <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 <br /> this application before a permit will be issued. Do not purchase or install 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 />