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7) <br /> Burnett County Office of Zoning Administrator iu 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < h <br /> shown herein. The undersigned agrees gthat all work shall be done in accordance with the requirements of the Burnett County Lind Use <br /> Ord <br /> Sani <br /> aws and regulations of <br /> ... .. .... .. ... . .. . O <br /> OWNERciple�OtP(ion) Code, and with all ot�pplicable County Ordinances <br /> ACTOR orISU RVEVOR or AGE NThe State of Wig <br /> Sir �t .......................................................... ".............. d <br /> ADDRESS ADDRESS <br /> ..... <br /> . . ... . . . . . .................................................................. c' � <br /> ................ <br /> ADDRESS ADDRESS ' <br /> ..........2/. -. G..-...2./.1...0..................... ....... ....... <br /> PHONE PHONE > <br /> ................................................. .......................... ..WELL.........DRI......LLER.................... ........................................... <br /> .......... <br /> PLUMBER I. <br /> . ...... . . ...................................................................:........... O <br /> ADDRESS ADDRESS n o <br /> 0........................................................................................... ............................................................................................ o <br /> PHONE PHONE �. Z H � <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: No. Bathrooms ///]]]�� <br /> �[ 2. New Building Details ••'• •"• d <br /> New Building „!\ Type of Co uction: y�//�/ �O ' <br /> ryr .......... (� N <br /> Addition Tr'u^^ e SepticTanks e Ga .......... V ,� <br /> .......... .........r� ............. ............. <br /> Sanitary .......... Size .os.`.�..... ft. x 3.a.... ft. .......... <br /> Filling/Grading .......... Height............. Stories .../......... 4a. Absorption Field Site: <br /> Moving ......... Area ........................................... Soil Type ........... <br /> Mobile Home Slope . ./rench <br /> ... . » <br /> PerC. Ra <br /> Privy ,......... 3. Use (describe exactly, 1 -family � ' '• •'•'•I"""�"" <br /> Well hoffne,garage, motel, etc.) Dry Wel .......... JJJ <br /> Subdivision .....„_.. Q-=Ar-CL CZ Seepage .......... Q <br /> ...... y <br /> Camping Unit ”............................... .......... <br /> Privy i <br /> Seepage Bed .......... <br /> .ad <br /> Location of proposed structures and existing structures well, sewage systems, roads etc., should be sketched in Fig A- Include road A C [� <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- QO- <br /> section, show the intersecting highways and the Setbacks required along them and at the intersection. CLEARLY LABEL EXISTING <br /> STRUCTURES AND PROPOSED STRUCTURES ----pITI ONS. ry C y h — o �\ <br /> I d ---- <br /> ------------------------------ �a S. .----tv.- ----- <br /> yotiLj <br /> ; <br /> ft. x ........ .r.......... <br /> 5. Lot Size: C/ <br /> Fig A. 6. Location, <br /> \ 0 <br /> old I`3� Adl bL� by D ['�1 <br /> �> 1001� P,wPo o c <br /> 0 <br /> 0 <br /> Q OG <br /> 0 <br /> d <br /> €� <br /> tn � � � 0 <br /> d d <br /> (96n � mo5. <br /> m n _ n <br /> 9 cn < y <br /> Z 0 0 D a <br /> O _ L <br /> K o . <br /> . ................................... ^....L.........8.ero C <br /> Signature <br /> ner r <br /> A nt Date <br /> X <br /> T <br /> Remarks ......................................................................................................................................................................... r� C <br /> v <br /> ........................................................................................................... ... .................. . ....... .............................. <br /> �......... <br /> Inspection Date ....................................... ... . .... .y7 .. . ................................... :tom <br /> N f m <br /> Zoning ministrator $ 0 0 0 0 0 <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 Adm inistratoi . <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />