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It- <br /> . f - .;+...�.,. Office of Zoning Administrator 0 <br /> Yy APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT o 3 <br /> �y <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a0_ o o :� <br /> Permit for the work described .and located as shown herein. The undersigned agrees that-all s I '• <br /> work shall be done in accordance with the requirements of the County Zoning Ordinance, a V '� <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- <br /> lations of the State of WijFconsin <br /> S1. 'rT . . �. .l.v� � . . _ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . a p <br /> Owner or Agent !please print) / Contracmr or Surveyor f <br /> i LVN .d.ST — l,vf .. . a <br /> T. . 06 <br /> Address 'Addressif <br /> a <br /> -. . ' . `f. . . . . . . . . . <br /> P <br /> �. . . . . <br /> hon Phone <br /> Plumber Well griller <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . :b _. :1 <br /> Addr¢SS . . . . . . <br /> Addn'.55 <br /> Y <br /> Phone Phone <br /> n g F� <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: a <br /> Type of Construgbn , No. Bathrooms <br /> 1. Work . _L�' .X�3(!,^r,,`T No. Bedrooms <br /> New Building . . . . . . Size . . . . . ft. x . . - C. It. Septic Tank Site Gals. <br /> Addition .. . . . Height . . . . . Stories . . . . . . f ry <br /> / tl ro : <br /> Sanitary - . .4-� Area . . . . . . . . . . . . . . . . . . . ]a.AbsorPtion Field Site: <br /> Filling . . . . . . Soil Type . . . . . . . . . . . . . . . <br /> Moving . . . . . . 5. Permits Required Slope . . . . . . . . . . . . . . . . . . . . <br /> Grading . . . . . . Subdivision /Pere. Rate . . . . . . . . . . . . . . . . . <br /> Mobile Home Sanitary t./ Dry Well <br /> Privy . . . . . . Building . . . . . . Seepage Trench . . . . . . m .� <br /> Well Well Privy » m :->S <br /> Subdivision . . _ . . Other (Specify) . . . . . . Seepage Bed �. Q/1 .-�(' 9 :ot i In <br /> 0 <br /> Conditional to <br /> 2. Classification Land Use \• n ,^. <br /> Zoning Dist. .RR-� o + <br /> iaa 0. Use (describe exact) 1 - fa ' I <br /> 3. i1a �� G home,motel,etc.) FOR COMMERCIAL USE ° r <br /> ° <br /> . . . . . . . ft.x . . . . . .�� it. Plans Submitted . . . . . . <br /> .. . . . . . . . . . . . . sq. ft. Plans Approved . .., . . . : I <br /> _________________________________________'_----__—__—____—_—__—__ <br /> Fig. A. Location of <br /> Vro Posed structures and y <br /> existing structures, well, sewage sys- <br /> terns, roads, etc., should be sketched •1 <br /> in Fig. A. Include road setback, side z <br /> and back yard f dimension and location :� a <br /> and setback from all bodies of water. <br /> If property is located at a highway in <br /> tersectioo, show the intersecting high !4J <br /> ways and the setbacks required along <br /> them and at the intersection. : l <br /> a � <br /> PERMIT FEES <br /> Subdivision..._ $25.00 + S2.00 per lot. L3 <br /> Land Use.......... ... $10.00 I <br /> Build icup..... ..._......_............... 70.00 l� <br /> Sat, nit.ry .................................. 35.00 t Q. <br /> J <br /> Well .._.................................... '10.00 <br /> Privy ...._....... ......................... 5.00 > �C <br /> �.....................{,I)nt <br /> ignaj7u .* ncr* ntDate Zoniny AAmntrstrazorInspection Date .. ................................. Inspector ..............._.......................... ....a'........._.................._....': .. <br /> Remarks ...........'............................. <br /> ............................................................................_..................... <br /> ...............................................__.... .... <br /> ............................................................. ! <br /> NOTE: A preliminary site inspection must be madeand site approval granted on all structures involving sanitary fai`i ei <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must he attacheil�tc <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 he"I <br /> with is found to exist. Changes in plans or specifications shall not be male without approval of the Zoning,Administrators <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />