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'County " Office of Zoning Administrator n 9 0 <br /> ? <br /> 0 <br /> - APPLICATION FORSANITARY — LAND USEE — BUILDING PERMIT <br /> TO .THE ZONING ADMINISTRATOR: The undersigned hereby makes application for _y _ o - <br /> Permit for the work described and located as shown herein.-The undersigned agrees that all Q <br /> work shall be done in accordance with the requirements of the County Zoning Ordinance, <br /> Sanitation Cod., and with all other applicable County Ordinances and the laws and regu <br /> m _ <br /> tattoos/of State of Wisconsin.r <br /> caner or Agent . <br /> Owner or Agent Iplease printf r q / 'Contractor or Surveyor <br /> .7-4F 'i . <br /> Address Address c <br /> 5 S/ y <br /> S � . . �'str .C . :.. rt ln .� , o. . . . . . . . . . . . . . . . . . . . y, <br /> Phone Phone <br /> Nonni. r .h. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> Well Driller r i <br /> 0 7 <br /> Address Address <br /> it o <br /> Phone Phone 0 <br /> o <br /> o. <br /> - DESCRIPTION 4. Building Details 7. Sanitary Facilitles �/ ° "a v <br /> Type of Coustruc(ien No. Bathrooms <br /> I. Work Dishwasher _ <br /> New Building . . . . . Size . .7. y ft. x . 73 7 ft. Garbage Grinder <br /> Addition . . Height . . . . . Stories . . . . . . Aulom. Laundry <br /> Sanitary Area No. Bedrooms <br /> Alterations . . . . . . Waste Disposal System <br /> Moving . . . . . . 5. Permits Required Septic Tank Size Gals. .7 j-s3 \4 � <br /> Wrecking . . . . . . Subdivision . . . . . . Absorption Field Site <br /> Mobile Home . . . . . . Sanitary Soil Type <br /> Privy . . . . . . Building . . . . — Slope . . . . . . <br /> Well . .. . Well Per.. Rate . . . . . . . . . . . . . . d <br /> Subdivision . . . . . . Other (Specify) . . . . . . Dry Well o 'c <br /> Conditional . . .,. . . Seepage Trench . . . . . . : ' s <br /> 2. Classification Land . . . . . . ,Privy o' <br /> Zoning Dist. 1 . . . . . . Seepage Bed / fK 3G Z o <br /> 6. Use (describe exact 1 -tam. <br /> 3. Lot Size home, motel,etc.) . . FOR COMMERCIAL USE <br /> At.x ; J `' ft. Plans Submitted n <br /> .. . . . . . . . . . . . . . . . . sq. ft Plans Approved . . . . . . a <br /> I <br /> i_________________ _____ ________________io __ proposed structures and <br /> F'g location of �/'` <br /> _ existingstructures, well, sewage s s <br /> • I_ tems, roads, etc., should be sketched :e <br /> Ig)r 9 s /�in Fig. A. Include road setback, side <br /> j d and back yard dimension and location <br /> IN 0 and setback from all bodies of water. <br /> r f property is located at a highway in N.C, i D <br /> CL <br /> ?� tersecti.n, show the intersecting high {� <br /> 1 ways and the setbacks required along ?�1 <br /> Lthem and at the intersection. <br /> r_3 6 A <br /> i � <br /> I� :I <br /> u .� PERMIT FEES <br /> _ <br /> I S' Aj $u bit iv ision $15.00 r� <br /> Land Use . . . . . . . . . . . 1.00 <br /> Building . . . . . . . . . . 0 \ <br /> Sanitary . . . . . . 10—� <br /> Well . . . . <br /> Septic Tank . . . . /ZD.00 <br /> Combination Building, Sanitary <br /> and Well . . . . . . . 15.00 <br /> I <br /> ���n <br /> Signature of caner yr Agent Date J onto dmin istrator <br /> Inspection Date . .... .IG..�.�._71................ InsPeclor . .._ .. ..... ............ .. <br /> t Remarks �7 ..tLa'.._..4.—P1,7�:� ................ .. <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 /> I this application before a permit will be issued. Do not purchase or install septic lank, 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 /> I <br />