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• BIMETT CC;jam;- -- • OFFICE OF ZONING ADMINISTRATOR r 1-3 �— <br /> APPLICATION FOR SANITARY - LAND USE - BUILDING PERM IT0 '� ' <br /> o <br /> Too t'le Z.on-i.nF Administrator: The undersigned hereby males 1 <br /> applied =. n.. �oPermit for a the work 'described and located as shown <br /> hereJ_r.. Y' n undersigned agrees that all work shall be done in actor- <br /> dan+: et). h the requirements of the County Zoning Ordinance, Sanitation a k.,.. <br /> Code, and with all other applicable County Ordinances and the laws and .i`\. o <br /> regulatiens of the State of Wisconsin. t i °' <br /> e Jo 5 Ef17 G kfliwE1- k _ _._ -- ... <br /> Owner or Agent (please print) Contractor ` t d <br /> Address Address <br /> Phone Phone 1 ,` <br /> .3 F‘ -5----LaL ________ ____ L) <br /> Plumber Well Driller <br /> fetti S < Fic- 4.' C CU? E/?k�Sr pp'c- 4' 6'6 ff- <br /> Address Address <br /> i'r. %1j,Se ill Cti) i,.. . tele 4, S'e iJ i S=- __.. 4) <br /> Phone Phone <br /> DESCRIPTION 4.. Buildin Details 7. Sanitary Facilities o <br /> 1. Work (check one) Type of Construction No. Bathrooms / 0 < �� <br /> <- <br /> New Building 6.sk, _ Dishwasher ___-_- 4o o <br /> Addition Garbage Grinder t' <br /> Size r ft x .3.. ft <br /> Sanitary Autom. Laundry (,y �,,. <br /> Alterations _ Height Stories_ No. Bedrooms c\ off, <br /> Moving ----- Area Waste Disposal System 1 <br /> Wrecking Septic Tank X ' t 0 <br /> -- 5,Permits Required ------� r '� <br /> Mobile Home Size Gallons m <br /> Flood PlainII <br /> Privy Sanitary • Absorption Field Site 4 <br /> fell Building X Soil Type .,„1, 4 tV&, . 1 <br /> 2. Classification Well Slone o <br /> Zoning Dist. -��__ Other(Specify) -..___ Perc. Rate w <br /> No. Bdrms. <br /> Conditional Seepage <br /> TlTren o 0 <br /> No. Apts. <br /> No. Employees ------_ Privy <br /> Parkinr; Spaces 6.Use (describe exact- Seepage Bed Imi: <br /> 3. Lot Size __. ly, 1-fam. home, FOR COMu,I;RCIAL USE <br /> ft x ft. motel, etc.) Plans Submitted o <br /> K _se. ft. Plans Approved cn <br /> _____,_ G co <br /> NOTE: A preliminary site inspection must be made and site approval I '� <br /> granted on all structures involving sanitary facilities before con- P. <br /> [g <br /> struction can begin. In the case of sewerage disposal systems, a o' <br /> copy of the percolation test must be attached to this application o <br /> before a permit will be issued. Do not purchase or install a sepBi <br /> - <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 o <br /> of the information conveyed herewith is found to exist. Changes �, <br /> in plans or specifications shall not be made without approval of <br /> the Zoning Administrator. SEDER SYSTEM SHALL NOT BE COVERED UNTIL <br /> INSPECTED BY THIS OFFICE AND APPROVED. <br />