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_ <br /> Surne�t County � Office of Zoning Administrator CD CD o � <br /> m o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT ° 3 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 <br /> work shall be done in accordance with the requirements of the County Zoning Ordinance, C <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- a f <br /> lations of the State of Wisconsin. a ^qt <br /> Owner or Agent (please print) Contractor or Surveyor H f <br /> --� - C <br /> CD I <br /> ou <br /> Address Address a ¢ <br /> (c j ; <br /> Phone Phone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . :� <br /> Plumber Well Driller �-�,"� <br /> Address Address <br /> 0 o <br /> < <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> o <br /> Phone Phone CD :3 <br /> CD o ° o <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: ° <br /> Type of Construction <br /> YP No. Bathrooms o zo • <br /> 1. Work l.✓�O!�. . . . . . . . . . . . . . . No. Bedrooms . . ° .a CD ;� <br /> New Building k . . Size ft. x . .`f a. . ft. Septic Tank Size Gals. 7 5.�. :� 7 <br /> Addition . . . . . . Height . . . . . Stories .I. . . . . . . . . . <br /> Sanitary . . . Area . . . . . . . . . . . . . 7a.Absorption Field Site: <br /> Filling . . . . . . Soil Type . . . . . . . . . . . . . . . . . . o <br /> Moving . . . . . . 5. Permits Required Slope . . . . . . . . . . . . . . . . . . . . <br /> Grading J Subdivision Perc. Rate <br /> Mobile Home . . . . . . Sanitary %'• Dry Well . . . . . . CD CD � <br /> Privy . . . . Building V Seepage Trench . . . . . . fD `D j1: <br /> Well .a- . . Well Priv Y <br /> Subdivision . . . . . . Other (Specify) . . . . . . Seepage Bed o <br /> Conditional . . . . N CD <br /> co2. Classification �Y� Land Use :0 0 <br /> Zoning Dist. !` a o <br /> 6. Use (describe exactlyC-f <br /> 3. Lot Size home, motel,etc.) FOR COMMERCIAL USE <br /> . . . . . . . . . ft. x . . . . . . . . ft. Plans Submitted �• <br /> . . . . . . . . . . . . . . . . . . sq. ft. Plans Approved . . . . . . <br /> ------------------------------------------------------------------ <br /> F Location of proposed structures and <br /> existing structures, well, sewage sys- o <br /> tems, roads, etc., should be sketched <br /> in Fig. A. Include road setback, side <br /> and back yard dimension and location -o <br /> n 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. :<" <br /> n b <br /> J� PERMIT FEES Y✓ ° <br /> Subdivision $15.00 `D <br /> f Land Use . . . . . . . . . . . 1.00 <br /> Building . . . . . . . . . . . 5.00 : \ <br /> Sanitary . . . . . . . . . . . 10.00 :ff� <br /> M A-A - Well . . . . . . . . . . . 0 <br /> Septic Tank . . . . . . . . . <br /> Combination Building, Sanitary <br /> and Well . . . . . . 15.00 I <br /> -- _ <br /> Privy . � <br /> .........:9 .9.................... ��./z %. ASi nat�Y f Owner or Agent Date Wing A inistrator <br /> InspectionDate . .!`! ........................`..I../J.. InspectAor ............................./............................................... .............. <br /> Remarks ... �� ....... 4.....�L� ?.. ................... :'"il:................ <br /> �.. <br /> ................................................................................................................................................................................................ <br /> ................................................................................................................................................................................................ <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 />