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' BU ETT CCUNTY OFFICE OF ZONING ADMINISTRATOR ,-:� . . <br /> R <br /> APPLICATION• FOR SANITARY - LAND USE - BUILDING PERMIT `' „ <br /> .-' P .l <br /> • <br /> To the Zoning Administrator: The undersigned hereby makes I <br /> application for a Permit for the work described and located as shown „ k <br /> herein. The undersigned agrees that all work shall be done in accor- a 1� <br /> dance with the requirements of the County Zoning Ordinance, Sanitation s s ?� <br /> Code, and with all other applicable Count: Ordinances and the laws ands c� <br /> regulations of the State of Wisconsin, <br /> yd t s /z INS ; , <br /> Owner or Agent please 4' Contractor . N.o p e se print) <br /> (f 9 2e--____4.1.0 eee 6 9 <br /> Address A ddrees T <br /> \, <br /> Ph hone '- phone m <br /> Plumber �_�� Well' `Driller " in-.,.-_•.. __ .t <br /> I--e-c. e_.-/t// . ,-....L.L5.____L_j__ ;NI . <br /> Address Address Q <br /> 2( s�^Gym- 2 Cf 12 <br /> Phone Phone .._..:..._.. • _. V..... t; <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities `' <br /> c <br /> 1. Work (check one) Type of Construction No. Bathrooms / <br /> New Building Dishwasher 1:-. ,--4 <br /> Addition Size ft x ft Garbage Grinder a;+ r , <br /> Sanitary -•--�- arrow... Autom. Laundry a 1- }'4? <br /> Alterations HeightStories oii <br /> _ No. Bedrols k <br /> Meving Area Disposal System w <br /> L`µ <br /> Wrecking .�,� 5;Permits Recuirec? Septi Ta i C- -- ,h, y V' <br /> Mobile Home Size ?S- c/Gallons ' ' b <br /> Privy Flood Plain Absorption Field Site (' <br /> Well Sanitary v`- Soil Type , _may '� ' <br /> 2. Classification �'- Building; Slope 7 _ 0 co <br /> Well -1 <br /> ZoningDist. _ Other(Specify) --- Perc. Ratee /' � k <br /> No. alms. ,1 Conditional `-`-""'- Dry 'dell �Y o <br /> No. Apts. end ------- Seepage Trench <br /> No. rnployees..�_.. Privy '_ fl ‘,. 1g,1 <br /> Parkin!, Spaces 6.Use describe exact- Seepage Bed N. <br /> Lot Size 0,4c,/?eS ly, 1-••fam. home, FOi Cai CIAL US_:� <br /> ft ., A. motel, etc.) Plans Submitted r0 d o <br /> „_, ,�_�s co 5 <br /> sr. ft. Plans Approved �' <br /> :,. N• <br /> NOTE: A preliminary- site inspection must be made and site approval p `Ti <br /> granted on all structures involving sanitary facilities before con- '_' ir <br /> struction can begin. In the case of sewerage disposal systems, a F' <br /> copy of the percolation test must be attached to this application , „ <br /> before a permit will be issued. Do not purchase or install a sep- i <br /> tic tank, do any plumbing or start any building until a permit has ` <br /> been issued. A permit may be revoked if misrepresentation of any m <br /> of the information conveyed herewith is found to exist. Changes I <br /> in plans or specifications shall not be made without approval of 0- <br /> the Zoning Administrator. SEDER SY3 ' i SHALL NOT BE COVERED UNTIL <br /> INSPECTED BY THIS OFFICE AND APPROVED. <br />