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anty _ Office of Zoning Administrator v/ 0 C Z, <br /> w F o <br /> .'PLICATION FOR SANITARY — LAND USE — BUILDING PERMIT PP .k,' <br /> .1E •ZONING ADMINISTRATOR: The undersigned hereby makes application for a o <br /> It for the work described and located as shown herein. The undersigned agrees that all r \r <br /> shall be done in accordance with the requirements of the County Zoning Ordinance, <br /> So..ataoion Code, and with all other applicable County Ordinances and the laws and regu <br /> )ations of the State of Wisconsin. ` (� J 7 <br /> ef <br /> Uwner or Agent (please print) Contractor or Surveyor '" ^ <br /> 1..4 l. .3.9. . '9 rR. 4.✓. .N. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . a <br /> Address Address a :� <br /> Phone Phone �C <br /> s <br /> Plumber Well Driller <br /> O <br /> Address Address a cl <br /> \9 O 2 <br /> Phone Phone :N n m0 Z <br /> o <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: / o ; ( \ <br /> Type yl Censtrction No. Bathrooms o o 'a i ^I <br /> 1. Work . . X!S .r.z�. . . . . . . No. Bedrooms <br /> New Building . . . . . . Size . . . . . it. x . . . . . . ft. Septic Tank Size Gals. . . . . . . [ .� <br /> Addition . . . . .. Height . . . . . Stories . . . . . . %.••.L^. {y1 w :n 1 <br /> Sanitar . . Area . . . . . . . . . . . . . . . . .. . 7a.Absorption Field Site: �l �:1�'1 o ly., <br /> Filling Y . . . . . . Soil Type . . . . . . . . . . . . . . . . . . V o s ' I <br /> Moving . . . . . . 5. Permits Required Slope . . . . . . . . . . . . . . . . . . . . :\\VV1I .fi <br /> Grading . . .. . . Subdivision . . . . . . Pere. Rate . . . . . . . . . . . . . . . . . <br /> Mobile Home . . . . . . Sanitary .! Dry Well . . . . . . n >•. <br /> Privy . . . . . . Building . . . Seepage Trench . . . . . . <br /> Well . . . .. . Well PrvY . . U is i i <br /> Subdivision . . . . . . Other (Specify) . . .. . . Seepage Bedus <br /> Conditional . . . . . til <br /> 2. Classification Land Use <br /> . . . . . . o. <br /> Zoning Dist. . . . . . . � :•� � � <br /> 6. Use Idescrihe exactly, fa ) u <br /> 3. Lot Size home,motel,etc.l FOR COMMERCIAL USEE;t <br /> ft. x . . . . . . .. ft. Plans Submitted . . . . . . it, <br /> .5. .,.1 <br /> —. . . . . r. . . sq. ft. Plans Approved . . <br /> B + a t w <br /> --------------------------------------------------------------- <br /> F'9 Location of proposed structures and .!C\i <br /> r existing structures, well, sewage I '� o <br /> terns, roads, etc., should be sketched <br /> in Fig. A. Include road setback, side <br /> and back yard dimension and location 1 <br /> / and setback from all bodies of water. \'x. <br /> X3 Ii property is located at a high <br /> y in- <br /> UU /, tersection, show the intersectingwahigh " <br /> ways and the setbacks required along1 <br /> yp n hem and at the intersection. <br /> 3A ,II� D (K �yaO � <br /> PERMIT FEES <br /> 3s KQ- Subdivision $75.00 <br /> (l Land Use . . . . . . . . . . . 1.00 <br /> Building . . . . . . . . . . 5.00 <br /> Sanitary 10.00 <br /> �•Q /JThtf ellani 5.00 :F <br /> SrN Septic Tank . . . . . 1000 <br /> W e�l Combination Building, Sanitary <br /> and Well . . . . . . 15.00 <br /> Privy . . . . . . . . . . . . 5.00 <br /> �n � _ _e' <br /> ignat re of Owner or Agent strator \\ <br /> 7.. .�.. .R .�.1...... ................ �7F2 !t7.. `..! i!!f`?` .. .. ._...... <br /> Inspection Date .. .. .. ..LC' Inspector /.�..�. .. ... <br /> y emarks / L...L?.. .....2.n.�.J�1 ?�?T1. 'at��..fll <br /> ".. ... .naS���- ................_....................._........_......................._............................................ J <br /> ec :re^ t..l..�.S.G•. <br /> 1eq.73............:................................_......... ........................:_.......................Y. <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary(aril iI <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached <br /> this application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start anybu <br /> in0 until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed hr <br /> with is found to exist.-Changes in plans or specifications shall not be made without approval of the Zoning Adm inistrai <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. I <br />