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—;.�ett County Office of Zoning Administrator r„ -a o –I Z <br /> M m d ° ° <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT ° 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a o i <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, x <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- _ a �..� <br /> lations of the State of Wisconsin. CL 0 <br /> 3 <br /> .�E' . . l 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 <br /> Owner or /Xgent (please print) Contractor or Surveyor I <br /> N <br /> . . . . . . ,fir : v1 <br /> Address Address a 'Z <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ./h�p.�.'a . . . . . . . . . . . . . . <br /> Phone Phone V : 1 `vim <br /> Ci Pry <br /> Plumber Well Driller 1 <br /> 1 O, <br /> 0 <br /> S.T. .. . . . . . . . . . . . . . . . . <br /> Address A. . . .ddre.ss. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G) <br /> m <br /> v <br /> o <br /> Phone Phone N r <br /> o <br /> DESCRIPTION 4. BuildingDetails <br /> 7. Sanitary Facilities: �► <br /> Type of Construction No. Bathrooms o Z 0 <br /> 1. Work J!,A7.14.0. . . . . . . . . . . No. Bedrooms �• . . ° CD y. <br /> New Building Size . . . . . ft. x . . . . . . ft. Septic Tank Size Gals. 7 5 C` :� :F• <br /> AdditionHeight . . . . . Stories . . . . . . . . . . . . <br /> Sanitary X. . Area 7a.Absorption Field Site: i U o <br /> Filling . . . . . . Soil Type 6P-4, 6G :ep,, r <br /> Moving Slope5. Permits Required <br /> Grading <br /> . . . . Subdivision , • • • • , Perc. Rate . . '. �". , . . <br /> Dr Well r.. �j <br /> Mobile Home . . . . . . Sanitary x" Y m m <br /> Privy . . . . . . Building Seepage Trench . . . . . . <br /> Well Well . . . . . . Privy . . . . . <br /> Subdivision . . . . . . Other (Specify) . . . . . . Seepage Bed . . c ib <br /> Conditional . . . . . . <br /> 2. Classification Land Use <br /> Zoning Dist. $ a o' <br /> 6. Use (describe exactly, 1 -fam. ;c <br /> 3. Lot Size home, motel,etc.) FOR COMMERCIAL USE ° <br /> . . . . . . . . . ft. x . . . . . . . . ft. ` 1 Plans Submitted . . . . . . <br /> . . . . . . . . sq. ft. �- '✓ R� Plans Approved <br />'-------------- -------pp . . . . . . <br /> 'Ser44"rE 70 Fig. A. Location of proposed structures and <br /> existing structures, well, sewage sys- ^ 0 <br /> tems, roads, etc., should be sketched <br /> in Fig. A. Include road setback, side ? <br /> and back yard dimension and location �" a <br /> and setback from all bodies of water. tv <br /> If property is located at a highway in- Ile <br /> tersection, show the intersecting high- <br /> T- i`r a' ways and the setbacks required along <br /> (n� them and at the intersection. <br /> Fit <br /> PERMIT FEES <br /> :T <br /> Subdivision . . . . . . . . . $15.00 :y D <br /> �C Y� Land Use . . . . . . . . . . . 1.00 <br /> Building . . . . . . . . . . . 5.00 <br /> Sanitary . . . . . . . . . . . 10.00 <br /> Well . . . . . . . . . . 5.00 <br /> Septic Tank . . . . . . . . • 10.00 C <br /> Combination Building, Sanitary <br /> W <br /> and Well . . . . . 15.00 <br /> Privy . . . . . . . . . . . . 5.00 N <br /> ............. ............... .... .................... <br /> Signature of Owner r Agent Date Z g Administrator <br /> .� ''77 v <br /> Inspection Date4-4 /.• <br /> 7>Y`.J. ... . ................. Inspector ... . ..... . . .. . ..........�........... <br /> Remarks ............................................................................................................ <br /> ................................................................................................................................................................................................ <br /> .............................................................................................................................................................................................P.. <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 />