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'Burneti County Office of Zoning Administrator N o --I Z <br /> m 0 0 <br /> APPLICATION FOR SANITARY — LAND USE BUILDING PERMIT 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a o <br /> Permit for the work described and located as shown herein. The undersigned agrees that all m r- <br /> work shall be done in accordance with the requirements of the County Zoning Ordinance, �? <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- a ° <br /> lations of the State of Wiscgnsin. a <br /> J - <br /> 9 .u�. . . . . . . . . <br /> Owner or Agent (please print) Contractor or Surveyor H <br /> : . a <br /> . . . . . . . . . . . . . . . . . . <br /> Address Address a :\� . <br /> Phone . . . . . . . . . . . . . . . . .Phone. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . — <br /> Phone <br /> Plumber . . . . . ill . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> Well�. . <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> Address Address m G> <br /> ° ° <br /> ' 0 `. <br /> �� . . ,�7.��. . <br /> Phone . . . . . . . . . . . . .Phone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . � H r- <br /> 0 0 <br /> M 0 <br /> DESCRIPTION 4. Building Details r 7. Sanitary Facilities: {� ° <br /> Type of Constf ,�Z�!111. <br /> No. Bathrooms �• • • o Z 00 <br /> 1. Work . . . . gl/ . . . No. Bedrooms <br /> New Building . . . . . . Size .✓. ft. x ft. Septic Tank Size Gals. p�Q� <br /> Addition . . . . . . Height . . . . . Stories . . . . . . <br /> Sanitary . . . Area . . . . . . . . . . . . . . . . . . . 7a.Absorption Field Site: <br /> Filling . . . . . . Soil Type . . . . . . . . . . . . . . . . . . o <br /> Moving . . . . . . 5. Permits Required Slope . . . . . . <br /> Grading . . . . . . Subdivision Perc. Rate <br /> Mobile Home . . . . . . Sanitary , Dry Well - <br /> Privy . . . . . . Building , . , , , • Seepage Trench . . . . . . <br /> Well . . . . . . Well Privy <br /> Subdivision Other (Specify) . . . . . . Seepage Bed 9�/Y70 <br /> Conditional . . . . . . \ N N <br /> 2. Classification Land Use . . . . . . (, ° <br /> Zoning Dist. . . . . . . ) a 0 <br /> 6. Use (describe exactly, 1 -fam. N' <br /> 3. Lot Size hom�etc.) FOR COMMERCIAL USE ° <br /> 7 <br /> ft. x . . . . . . ft. � Plans Submitted . . . . . . � <br /> �. . . sq. ft. ��✓ ) l Plans Approved . . . . . . : :U <br /> -------------------------- ----------------- ------------ : :� <br /> Fig. A. Location ofproposed structures and <br /> existing structures, well, sewage sys- ( o <br /> tems, roads, etc., should be sketched C <br /> in Fig. A. Include road setback, side <br /> and back yard dimension and location <br /> and setback from all bodies of water. > <br /> If property is located at a highway in- <br /> tersection, show the intersecting high- <br /> ways and the setbacks required along <br /> them and at the intersection. T <br /> PERMIT FEESJAI,/ <br /> Subdivision.....$25.00 + $2.00 per lot. <br /> Land Use................................. $10.00 <br /> Building................................... 10.00 <br /> Sanitary .................................. 20.00 <br /> Well ........................................ 10.00 <br /> Septic Tank ............................ 10.00 <br /> Privy ....................................... 5.00 <br /> a ... 'c !�.... .....�/1.... ...h��.... ......... ....G ... <br /> ... .. . ............................. <br /> Signa re of Owner or Agent D e Zoni inistrator <br /> Inspection Date .../140 -.0—Y......................... Inspector .....vu v.. 'l/........................................................... <br /> RemarksClill:... .T11..e0!/Ej�..................................................................................................................... <br /> ................................................................................................................................................................................................ <br /> ..................................................................................................................................................................................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 Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />