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27(-c)47 L�. <br /> Burnett County Office of Zoning Administrator W //o <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 '� C <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the ,$ c <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and <br /> regula sof the State f Wiin. N q <br /> � <br /> . ........... . . .......... ...... . . . <br /> OW E please grin CONTRACTOR or SURVEYOR or AGENT <br /> o <br /> _ ..J�'�Z..`d ..die .G.6......... ............................................................................................ e <br /> ADQR�SS r ADDRESS m <br /> . ....s5�.�(3.� . .......................................................................................... <br /> AESS C-1 I <br /> A ) ADDRESS <br /> . -.7/4z............................................ .....PHONE....................................................................................... �T <br /> PHO : 1 v <br /> .......... <br /> ........................................................................................... . . ....... .. ............................................................. <br /> PLUMBER WE.. ..LL DRILLER.. .... <br /> O <br /> ........................................................................................... 'A-D-b... <br /> S.............................................................................. '/ V <br /> ADDRESS G <br /> < 3` <br /> ........................................................................................... . .......................................... ....................................... O 1 <br /> PHONE PHONE........ Z <br /> DESCRIPTION 4. SanitaryFacilities: ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms .......... c <br /> New Building ,.-.).� Type nstruc 'on: No. Bedrooms .......... R <br /> Addition ,,, Septic Tank Size Gals. .......... <br /> .......... ....... ..... ..'..1.. . .... <br /> Sanitary .......... Size ......h.. ft. x . .......... - <br /> P .a.. ft. i <br /> Filling/Grading .,,,,,,,,. Height..... ....... Stories .... .......... 4a. Absorption Field Site: <br /> Moving Soil Type .................................... i r <br /> .......... Area ........................................... p <br /> Mobile Home .......... Slope .......................................... ^ <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Well .......... home, ara a motel,etc.) Y <br /> Dr Well .......... m <br /> Subdivision .,.,,-,,,, Seepage Trench .......... o ' <br /> ........ ... .. . . �1(:1.�................ i <br /> Camping Unit .......... Privy .......... <br /> .................................................... <br /> Seepage Bed .......... <br /> .Q. <br /> ---------------------------------------------------------- : 1 r n <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. <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. T o <br /> --- - --- G <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. - ............................... sq.ft. ............................................................................... <br /> C6 70 <br /> O U' 7 <br /> vposr 0 <br /> RR6E `— <br /> air L40± Lines <br /> o <br /> Ej <br /> ]7 <br /> a <br /> e <br /> m <br /> n <br /> H _ <br /> m Nn�c � nm asy <br /> O m m <br /> Z^O D 1 <br /> o 2 n y <br /> o co m <br /> O <br /> 9. 5� A <br /> 0 <br /> Signature of'. f ..o-gent D'.. ...... ....................ate...... ...b..7 <br /> M <br /> p . <br /> SOwner or Ag <br /> m H . <br /> Remarks ......................................................................................................................................................................... m _ <br /> m .. <br /> o . o <br /> b o <br /> ..Inspection Date ....................................... ......... ........ N u, P1. <br /> )i <br /> iZoningAd. <br /> o g o g $ <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 />