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Burnett County Office of Zoning Administrator C(JCD CD oi <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMITCD <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a -i r o <br /> Permit for the work described and located as shown herein. The undersigned agrees that all <br /> work shall be done in accordance with the requirements of the County Zoning Ordinance, 77 CD <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- -o o- r- <br /> la ions of the State of W' on in. —CD `+- <br /> r <br /> Owner or Agent (pleaseprint) �/ 1r Contractor 9t H (n �� <br /> g210O7 / &r Mile .le . /V , CD � <br /> Address K.,M N . hi. J - Address a <br /> P oQ 0-, <br /> Phone Phone R <br /> ./ <br /> I em <br /> Plumber Well Driller ,, �a <br /> o <br /> Address Address m C) t0 <br /> 0 <br /> r+ <br /> -S <br /> Phone Phone ee ernyc m o r3 <br /> y <br /> CD <br /> rt o <br /> o <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: �� <br /> Type of Co tru9ti4xi„ No. Bathrooms z z o <br /> o 1. Work T (�(,//f p� . . . No. Bedrooms o C <br /> New Building Size . �U. ft. x . (J. ft. Septic Tank Sizg Gals. , . . :� <br /> Addition Height Stories ex% -f- 7.5 ci e <br /> Sanitary Area 7a.Absorption Field Site: r. <br /> Filling Soil Type o <br /> e r* <br /> Slo <br /> Moving 5. Permits Required p Q <br /> Grading Subdivision Perc. Rate <br /> 11 11 <br /> Mobile Home Sanitary I Dry WellCD CD <br /> Privy Building . .V.• . Seepage Trench CD CD <br /> fil <br /> Well Well Privy &' <br /> Subdivision Other (Specify) Seepage Bed �oZX � Cr\ <br /> o <br /> Conditional N v) <br /> CD <br /> 2. Classification <br /> i(----,.....42...s. <br /> �� Land Use a 0 <br /> Zoning Dist. -• o' <br /> o <br /> 6. Use (describe exactly, 1 -fam. _' <br /> 3. Lot Size home, motel,etc.) FOR COMMERCIAL USE o ~-' <br /> • J ///� ft ft. Plans Submitted t <br /> . 0(�iL'icPJ -ertt prN Plans Approved -- `1. <br /> Fig. A. Location of proposed structures and (S)' <br /> existing structures, well, sewage sys o <br /> tems, roads, etc., should be sketched <br /> -9.g(2 in Fig. A. Include road setback, side r- <br /> and back yard dimension and location = -o. <br /> and setback from all bodies of water. .—' <br /> If property is located at a highway in- <br /> tersection, show the intersecting high- i- Q <br /> N°� ways and the setbacks required along <br /> /0 y e r Il them and at the intersection. <br /> fid, <br /> (AO is l '� �o <br /> /l Q� l�° e� PERMIT FEES (� m <br /> At -j SD c7 (� m <br /> i Subdivision $15.00 <br /> 4----" ()°TTS' 12" Land Use 1.00 '� <br /> Building (5.00) N <br /> Sanitary 10.00 <br /> Well 5.00 <br /> Septic Tank f?00 <br /> Combination Building, Sanitary <br /> and Well 15.00 <br /> Privy 5.00 <br /> h/ 1 <br /> ....._:. '6 old .G:. 47—/5:27Y Aiti I <br /> Signature of Owner or Agent Date g,.ministrator <br /> i <br /> Inspection Date Inspector <br /> Remarks <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 />