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Office of Zoning Administrittor L c
<br /> PLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3
<br /> Z .KING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work describec and Uj
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<br /> as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements o the r$ -
<br /> ,t County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the law and 3 �J
<br /> .dgul ns of the State of Wisconsin. _
<br /> ...nR (Pie. se pgn,..4�Is:el.je- -�.......................... . ....... .r- . . . .....................................I...... .......
<br /> OW R (plesx pnn ! CONTRACTOR or SURVEYOR or AGENT `r
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<br /> � ADDRESS
<br /> d(AU1.y.....l�l �....:����......... . .................................................................................. .......
<br /> ADDRESS ADDRESS
<br /> PHONE .................................................................................... .......
<br /> PHONE
<br /> WELL DRILL
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<br /> PLUMBER ER
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<br /> ADDRESS ADDRESS
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<br /> DESCRIPTION 4. SanitaryFacilities: ° o
<br /> 1. Work: 2. New Building Details No. Bathrooms ....
<br /> New Building ,,,,,,,`, T p of structs n: No. Bedrooms ....
<br /> ^X\ y�q .. ...
<br /> Addition ..Y.SJ. r�t-�»� Septic Tank Size Gals. .. .......
<br /> Sanitary .,........ Size . .. ft. x ....5�.... .. ft. .. ....... i
<br /> Filling/Grading .......... Height.....�.^.. (Stories ............ .. 4a. Absorption Field Site:
<br /> Moving .......... Area .......c74J ........................... Soil Type ............................ .......
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<br /> Mobile,Home Slope :e o
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<br /> Privy ,,,,,,.,.. 3. Use (describe exactly,'1 -family Perc. Rate ........................... m. ...... ;]J
<br /> Well ,,,,,,,.., ho e,garage,motel, etc.) Dry Well ... ...... = t
<br /> Subdivision �j Ye (� Seepage Trench ... ...... o
<br /> .......... fs.QQ.f ...Q.....g...L W.;�. . ..
<br /> Camping Unit .......... - : Priv i
<br /> �...44(21.CS'E. I��( L�tl. . v
<br /> ____________ Seepage Bed .....
<br /> Location of proposed structures and existing structures well sewage systems, roads, etc., should be sketched in Fi A. .� N
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<br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is local .d at '�'- �
<br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersect on. �
<br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. (. -
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<br /> _ ____ __5. Lo Fig. A. 6. Location: _ :(
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<br /> Sig44tura of Owner or Agent Date
<br /> Remarks
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<br /> Inspection Date ....................................... . GG1n.F.r,1.r. .1-1......`f..Cl.�rJ.L(,. .5rf. ..... ..... . N N O O g m
<br /> Zoning Administr t r - 7 8888 y
<br /> NOTE: A preliminary site inspection must be made and site app" granted on all structures involving sanitary facil ties before construction
<br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this applici ition before a permit will
<br /> be issued. Do not purchase or install a septic tank, do any plumbing or start any building until a permit has been i ssued. A permit may be
<br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans orspecifications shall not be
<br /> made without approval of the Zoning Administrator.
<br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APP OVED.
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