Laserfiche WebLink
Burnett County Office of Zoning Administrator '{ <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT m 3• ) <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and # :� <br /> located as shown \ undersigned <br /> Gdrsig tttg , work <br /> shall <br /> naccordance <br /> requirements <br /> he m <br /> Bu County oiSanaion Codeand with all other applicableCouny Ordinances and the laws and <br /> regulations of the St of Wise si ......... ........................�... .......... ..... ... ... .. ....... .... ................................ . ......... . .......... <br /> 4p <br /> ((NER (please, CONTRACTOR or SURVEYOR or AGENT •� <br /> rJp.:.............. ........................................................... ........................................ ..... a r6 <br /> ADD ` p ADDRESS <br /> Ai� <br /> ff ........ ............................................................................. <br /> I <br /> ADDRESS V ADDRESS <br /> ...............................- �� . <br /> � ................................... ......................................................................................IL.... t <br /> PHON PHONE <br /> J.. . .................... ........... .. .....r....................... .................. <br /> PLUMBEP IVa' L WELL DRILLER..............................................................I�jf..... <br /> I , 1 1 i .. <br /> .... .. . ...lr�J.Q.t : . ....r. W. S <br /> ADDRESS / _ ^' O ADDRESS m •0 ice" <br /> ...........................................................................II...... o <br /> PHONE PHONE Z « r . <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms c <br /> New Building ..X... Type of Construction: No. Bedrooms <br /> Addition - ,„ ,,,,,,•••,••••,,,,,,,,. Septic Tank Size Gals. .. .. <br /> SeMte ....y...-..... Size .t........... ft. x ft. Soil Type ... ...........j...... <br /> Filling/GradingF�...... Height...............Stories................ .. . <br /> Mobile Home .......... ........ P YP �...... {...... +aV •0 i <br /> Moven Area 4a. Absorption Field Site: C <br /> Sl <br /> 9 <br /> .......... Dry Well e ............ ..... . . 2i <br /> 71 <br /> Well ome garage,motel, etc.) 1 <br /> Priv 3. Use (d 9scri9e exec 1 -famil y {� m <br /> ( ... <br /> .— 5(_ <br /> Privy <br /> Subdivision Seepage Trench ...J...... Z 1 f <br /> .......... .................................................... <br /> Camping Unit Privy <br /> Seepage Bed e <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 9.)a highway 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. t L� 1 0 <br /> ___________________________________________________________________ <br /> 5. Lot Size: Fig. A. 6. Location: <br /> . ft. x . .?:'eft. — s ft. ....... <br /> .............................. <br /> q• I <br /> U <br /> N ' O <br /> O C J <br /> 0 <br /> 0 <br /> � oa <br /> -Dr�) r�/6 III I <br /> vy as O <br /> 7D <br /> I W <br /> y� J <br /> ill 1 N_ <br /> li 9 C.- <br /> --v <br /> j1nD W co -C <br /> h <br /> omm ; <br /> Zino` : > 1 <br /> o c m <br /> - :sx m <br /> � 0 <br /> ............................................. ............................. A m <br /> Signature of Owner or Agent Date g <br /> Remarks m ' m <br /> w <br /> ........................................................................................................ ... ...................... .iI .................. TI <br /> ..... N O N N m <br /> ....... .. ... <br /> Inspection Date ....................................... 1?? f.......r........1. �L.. . .. .......... u v�u o o v m <br /> Zoning Adminlstrat 7) 8 8 8 8 8 8 rn <br /> NOTE: A preliminary site inspection must be made and site app” "I 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 per^" <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 <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or gpecificatiot <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />