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Burnett County Office of Zoning Administrator 0 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <br /> 0 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < 7 <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws regulafions of the State of Wi nan. <br /> / L J f f o <br /> .... Jn( S1 !..`P...............t....... .............. .d..' ...............de...`&..........e4..r? o....... <br /> OWNER (pleas tint) k /� CONTRACTOR or SURVEYOR or AGENT m 7 <br /> /r...........'.'.!:?.Q..�':./.'5....... . .. .... ..... . ............. ................................................................................. 'Tl <br /> AD RESS .!S;r%' ADDRESS <br /> ........................................................................................... .ADD.. .. RES. ...................................................................................... <br /> ADDRESS S <br /> in <br /> .................... . ........................................................... ............................................................................................ � <br /> PH E PHONE ; <br /> //r(T}/N I ..........,...................................................... . ........... .. . . ....................................................................... <br /> PLl1MWELL DRILLER <br /> ADDRESS ADDRESS m G1 <br /> O O <br /> ........................................................................................... ............................................................................................ o <br /> PHONE PHONE Z <br /> DESCRIPTION ° ° <br /> . Sanitary Facilities: or <br /> 1. Work: 2. New Building Details No. Bathrooms <br /> '•"""" n:N'j o � <br /> g .......... Type of Construc•ti : No. Bedrooms .......... 3 a ip <br /> New Building T .� <br /> Addition ,,,, ,•, �'Q e Septic Tank Size Gals. .......... <br /> Sanitary ...;IC... Size .............. ft. x .............. ft. � n <br /> Filling Grading ....... Height............. Stories ............... 4a. Absorption Field Site: : <br /> Moving .......... Area Soil Type .......................... ......... r i <br /> ........................................... <br /> Mobile HomeSlope .......................................... �o o <br /> .......... <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... r i <br /> Well .......... home, garage, motel, etc.) Dry Well .......... <br /> SubdivisionSeepage Trench .......... <br /> Camping Unit ... .................................................... <br /> ....... Privy .......... r :F <br /> .................................................... Seepage Bed ov/ �w it <br /> : 1 <br /> 7. .. <br /> it <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched in Fig. A. Include road <br /> setback, side and back yard dimension and location and setback from all bodies of water_ If property is located at a highway inter- is. E- <br /> J <br /> section, show the intersecting highways and the setbacks required along them and at the Intersection_ CLEARLY LABEL EXISTINGr < o <br /> STR UCTUH FS AND PROPOSED STRUCTURES AND ADDITIONS. p' <br /> ---.-----------------------------__—_______ __--_—__—_— <br /> .Z11 <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ............................................................................... <br /> ................ ft. x .............. f/yt.+/— .................. sq. ft. Q� <br /> N O <br /> O <br /> � ba <br /> O <br /> I <br /> I m <br /> Z C <br /> 0 <br /> 7 <br /> d <br /> c <br /> (n r m tp 2 <br /> m <br /> Z o o a � <br /> \o <br /> W <br /> �- 9-`Go p <br /> Signatu e of Ownhat r A ant Date :`�^ — <br /> Remarks .f�.....r ...✓'.".... ... . . .................... ....................... .......................................................... X v <br /> ..... 2...a. .: �..... ZZ <br /> _...................................................... 0 II <br /> �j f �• ...... ...............Zonl .............................................. <br /> Inspection Date .G......`�'...��`..��............. C//'(%;' .... .................. ...................... : \� U o 0 i � m <br /> o: <br /> Administrator 0 0 . 00 . 0 c/) <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 />