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Burnett County Office of Zoning Administrator <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 '� ~ 0 !""" <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> -11 <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and <br /> regulatio the State of W' onset, n <br /> �nic�. .. . ................... .... se ................................................................. A <br /> OWNER II ri 1 CONTRACTOR or SURVEYOR or AGENT ?� <br /> ADDRES ADDRESS m <br /> yt N� <br /> yc�n,.. s.....1?'1�............. ........... . . . . ................................................................................... <br /> ADDRESS ADDRESS <br /> ............................................................................................ ...........,................................................................................ <br /> PHON PHONE <br /> ..-...��8.y.....-. y.Y....C�.................. ............................................................................................ v . <br /> PLUMBER WELL DRILLER <br /> ........................................................................................... ......ADDR......ES................................................................................ _. K <br /> ADDRESS S n o <br /> c <br /> j Zk <br /> ........................................................................................... . .............................. ........ ....................................... .: <br /> PHONE PHONE........ Z N 0 <br /> DESCRIPTION 4. SanitaryFacilities: ° o <br /> 1. Work: 2. New Building Details No. Bathrooms- <br /> New BuildingType of Construction: No. Bedr ms .......... R <br /> ---'-- Sept' ank Size Gals. <br /> Addition .......... ................ .......... <br /> .......... . <br /> Sanitary .......... Size ....- ..... ft. x .............. ft. i <br /> 4a. Absorption Fi d Site: . <br /> ..... <br /> Filling/Grading Height............. Stories ............... i <br /> Moving it e .................................. r <br /> .......... Area ........................................... YP O <br /> Mobile Home SIOPe .. ....................................... .. <br /> Privy .......... 3. Use (describe exactly,'1 -family Perc. ate ................................... 0 <br /> Dr ell <br /> Well .......... t10 <br /> gars e, motel,etc.) """"" — - <br /> Subdivision epaga Trench o <br /> .... fivy <br /> fiv . f .......... <br /> Camping Unit .......... ....... :W <br /> Seepage Bed ......... :' <br /> -------------------------- __ ___________________ <br /> _ <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 ST R AES-ANO PROPOSED STRUCTURES AND ADDITIONS. _ :� 0 <br /> T� <br /> 5. Lot Size: Fig. A. 6. Location: � .-� E <br /> ................ ft. x ........ ..... ft. — � .... sq.f . - e <br /> ................ .� . <br /> N O <br /> O aC 7 <br /> O <br /> — <br /> 7J w ; <br /> 7J <br /> 4- <br /> k4rezk <br /> k4rezk KS�'OSP-G <br /> 3F5oo <br /> � Z <br /> 0 <br /> d <br /> n be- <br /> seP��� °< <br /> 1 o c c <br /> J �" tl�' ' Vin : m <br /> Sim � ° O <br /> Jo � : <br /> igna�Ofwneror gent ate o <br /> N <br /> Remarks <br /> w <br /> ........................................................................................................................................................................................ 1 0 <br /> ........... r F <br /> o . g <br /> � 'n <br /> Inspection Date ... ,' �N' .u�' o N m <br /> ....................................... ............ 9 m <br /> onin Admi istrator $ 8 c g N <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities before constr ction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this application before a perms 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 ma 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 />