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.Burner" County Office of Zoning Administrator 0 l-a o --1 Z <br /> m m y p O <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT �, 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 y L <br /> work shall be done in accordance with the requirements of the County Zoning Ordinance, <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- <br /> lations of the State of Wisconsin. O <br /> Owner cAgent (please print) Contractor or Surveyor if <br /> y. 4Y. N. . '�'r 'r � ��yti zTrr„� f, r4 n„ S 5'y`/ 3. . . . . . . . . a ;� <br /> Address Address a <br /> Phon Phone <br /> '. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> Plumber Well Driller <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> Address Address 0 o <br /> o <br /> . . .ne. . . .Ph. one. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . y <br /> Pho7 <br /> � o <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: <br /> Type o ons ruction No. Bathrooms o Z °a <br /> 1. Work I. a'.7r. . Ctiti�'r- No. Bedrooms <br /> New Building . . . . . . Size . . . . . ft. x . . . . . . ft. Septic Tank Size Gals. . . . . . . <br /> Addition Height . . . . . Stories . . . . . . <br /> Sanitary Area . . . . . . . . . . . . . . . . . . . 7a.Absorption Field Site: <br /> ti A <br /> Filling Soil Type • • • • • o <br /> Moving . . . . . . 5. Permits Required Slope . . . . . . . . . 0 . . . . . . . . . . <br /> Grading . . . . . . Subdivision • • , • , • Perc. Rate :V\ <br /> Mobile Home . . . . . . Sanitary ( ! Dry Well . . . . . . �. <br /> Privy . . . . . . Building Seepage Trench . . . . . . D m <br /> Well . . . . . . Well Privy <br /> Subdivision Other (Specify) Seepage BedCn <br /> !. . . . <br /> Conditional . . . . . . -=Cn <br /> c w <br /> 2. Classification p Land Use . . . . . . a <br /> Zoning Dist. <br /> 6. Use (describe exact61 -fam. <br /> 3. Lot Size home, motel,etc.) FOR COMMERCIAL USE ° <br /> . . ft. x y.� ft. Plans Submitted . . . . . . <br /> sq. ft. Plans Approved (� <br /> Fig. A. Location of proposed structures and ;� G <br /> existing structures, well, sewage sys- :n O <br /> tems, roads, etc., should be sketched ED <br /> in Fig. A. Include road setback, side s <br /> and back yard dimension and location <br /> and setback from all bodies of water. x-- <br /> If property is located ata highway in- <br /> tersection, show the intersecting high- <br /> ways and the setbacks required along T y <br /> them and at the intersection. <br /> PERMIT FEES :~ <br /> Subdivision.....$25.00 + $2.00 per lot. m <br /> Land Use................................. $10.00 <br /> Building................................... 10.00 '_` <br /> Sanitary ................................� 'C,. - 7 <br /> Well ........................................ 10 �• <br /> Septic Tank ............................ /S•0 (e <br /> C (i Privy ....................................... 5.00 <br /> l . .............. �-.1. -.��......... ........................... <br /> Iignpture of wner or Agent Date Zoning Adrtlinistrator <br /> Inspection Date .. . ..`. d.............. Inspector .. ... ................................... <br /> Remarks \!1.. .....� ...:...................;: .. ........................... <br /> ................................................................................................................................................................................................ <br /> ..................................................................................................................................................................................0............. <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 />