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Burnett County Office of Zoning Administrator -g4 <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 •z <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 appli!rable County Ordinances and the laws and 3 <br /> regulltionst eStat`ee ffjwisgopsi. <br /> ..... ...... ...1..-....tl-e.................I...................... ......`. .................................................................................. n <br /> OWNER 1plaeseprintl CONTRACTOR or SURVEYOR or AGENT <br /> /- a <br /> al <br /> w ............................... o.u....i.�a.............. ............................................................................................ d <br /> ADDRESS6ADDRESS <br /> .........( �� ..I....(rt1%5. ................................. ..... . . . . . <br /> ADDRESS �! ^ ' � ADDRESS <br /> PHONE// /� I / ,��.�/�`�//� PHONE •��\1 <br /> ......... ......1/.... ....../................�......l..................................... ............................................................................................ Q�J <br /> PLUMB R . �! WELL DRILLER i� <br /> qquv ..� .. .......................................................................... 0 <br /> .......... <br /> ... .....................1.... ........................................ .. .. ........... <br /> ADDRE t�� 6 ^l o� ADDRESS <br /> ................................... n o <br /> . . ......................................................................... . . ................................. ............... - O '4 <br /> PHONE PHONE...... Z H r <br /> DESCRIPTION 4. Sanitary Facilities: ° c <br /> 1. Work: 2. New Building Details No. Bathrooms �z.... -9 0 <br /> New BuildingNo. Bedrooms ....7.... <br /> „X,,,, Ty of Construction: <br /> Addition ,,,,p„Y�m,� Septic Tank Size Gals. �..0' <br /> Sanitary .. .... Size ....... ft. x ...x.47... ft. .......... <br /> Filling/Grading ,,........ Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving Soil Type ..... ... •r <br /> .......... Area ........................................... <br /> Slope ............ .. 0...................... _ a <br /> Mobile Home .......... T <br /> Privy 3. Use (de a exactly, '1 -family Perc. Rate ......3.:',3.... .......... N <br /> Dry g g , motel,etc. Or Well .......... t <br /> Well ,,........ hom ara — <br /> Seepage Trench o <br /> --Camps Subdivtalon-- ... <br /> .......... ...... ........qq..................h...N........ <br /> - ----------------- <br /> Camping Unit .......... ......'.1.X g...q.U[Y. .. . Seep ..... " <br /> 1" U' -- - • Seepage Bed . . ... <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. %-Cr <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is located at <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 /> i� <br /> ................ ft. x .............. ft. — ............................... sq.ft. ............................................................................... <br /> ^^-- LQ iQ <br /> 0 ` 0 <br /> /1 {\ <br /> 0 6 : S <br /> iT <br /> T ' <br /> R :Z <br /> 9 <br /> m <br /> J <br /> m "ate Z' 3 0 nny <br /> ao< mCy > > 3 <br /> O N N O b 0 <br /> Z o � D 1 <br /> ma : y <br /> 6 a-�`7 0 - <br /> ............... .....i................ ............................ ......... o <br /> c <br /> s <br /> Signature off Owner or gent Date $ <br /> Remarks G.':: �. � T ' n <br /> ... .... ... .................................................................................................................................................... <br /> S : $ <br /> 7Ins <br /> Inspection Date ....................................... N( fNT gO NNoZoning Administr r <br /> T <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. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />