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Burnet;County Office of Zoning Administrator �' ✓gamg <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and m » 0p <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m c <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and <br /> regulati sof the Sta eo f IN cousin. <br /> ............................................ <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT <br /> S�T�/• ... ...... ....................................... .ADDRESS............................................................................ r}cc�_ <br /> ADDRESS a SJ _ <br /> ................. I�Iti L t4.M lCL�3Com/ <br /> ...... ........... . . . . ...... -' .y.J <br /> ADDR SS ADDRESS <br /> .....��a�.-..`...A..`.�..", ..................................... ... . . . . <br /> PHONE . . . . ................................................................................. 1 '� <br /> PHONE <br /> ................. <br /> .......................................................................... . . . ..D..RIL.. L...... ........................ <br /> ....... <br /> ................ <br /> ....... <br /> ............... <br /> PLUMBER WELL ER.. <br /> AODRESS .A...D....RESS.................................................................................... <br /> D 0' C <br /> . . .................................................................... .PHONE................................................................................ N <br /> PHONE .: <br /> DESCRIPTION o o E <br /> 4. Sanitary Facilities: o » <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details o <br /> New Building T' No. Bedrooms ' <br /> Type of No. <br /> Addition Septic Tank Size Gals. .......... R <br /> ................ <br /> Saul Size ............. . x .............. ft. <br /> Rlllingl Dreding� .,.�(,,, Height .......... Stories ............... 4a. Absorption Field Site: ` '• <br /> Moving .......... Are Soil Type .................................... i rr i <br /> .......... ................................ <br /> Mobile Home <br /> o <br /> .......... $IOPe .......................................... » <br /> Privy .......... 3. Use (describe exa tly,'1 -family Perc. Rate ................................... m <br /> Well .......... home,gar , motel, etc.) Dry Well <br /> n <br /> .. ... ................. <br /> Seepage Trench jz <br /> .......... .......... <br /> Camping Unit ...................... Privy o <br /> ......... .................................................... .......... <br /> Seepage Bed <br /> —— <br /> — ( <br /> " <br /> .......... <br /> ----------------------- r i <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc. should be sketched in Fig. A. .N <br /> C <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property d located ;� ro g - <br /> ahighway 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 /> 5. Lot Size: ••�� Fig. A. 6. Location, <br /> � ..:..... <br /> ft. x, .-2(?... ft. . ......... .................. sq.ft. .......... ! �2.Yrtrsof... :........................ <br /> 0 <br /> be e 1� f sfe� Iti � t o� <br /> a <br /> Ppm 1 a <br /> I Jl rn v W r D m co -0 <br /> �RGp' ` 's be vt l � bL.+``%ee.— �w b�ti C� Ald M « o < > > .0 __. m <br /> m N a� a m EL <br /> { o f 57zsk� e� sQ 6 l na/l �El�� be se ( f- rwklc/ � $y N ici <br /> 3_ <br /> SOC'LQ'•afit I IH�G cr 4 rcrl✓vj( r P tui, : y M <br /> lV\ !(JA a : y <br /> �oC 54Z4 , O : D <br /> S p <br /> ature of Owner or A nt :" a <br /> $ ; <br /> m •• <br /> 0 <br /> Remarks <br /> w <br /> Inspection Date ....................................... <br /> Zon' g Adminis for $ $ $ $ g In <br /> NOTE: A preliminary site inspection must be made and site a oval 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 />