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rip <br /> j- au.nett County – Office of Zoning Administrator rt 9 of 0 <br /> 1, z <br /> �. YTS ... . O O <br /> APPLICATION FOR — LAND USE . BUILDING PERMIT <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes grtion fora G <br /> Permit for the work described and located as shown herein. The undersigneedd aagreees that all <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 /> lat/iolns of the State of Wisconsin. 3 c <br /> f <br /> Owner <br /> torA . . . . int) /. �. _ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . n i� a <br /> I Owner or Ag�t (Please print) �(� c -�^ Contractor or Surveyor <br /> Jp <br /> Address Address <br /> . . . . . . . . .: <br /> Phone. . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . <br /> r <br /> ph,mllerWell Driller 'J / <br /> Z <br /> . . . . . . . . . . . <br /> Adddreressss. . . . . . . . . . . . . . . . . . . ! — — , r <br /> Address I � O <br /> V o 0 <br /> Phone Phone o Qom' <br /> 0 <br /> DESCRIPTION 4. Building Details7. Sanitary Facilities: cr <br /> Type of Construction No. Bathrooms a�' o z o ,' <br /> 1. Work . r'' ' 'I`� No. Bedrooms <br /> New Building . . �/ Size . �.tl ft. x . J.� . ft. Septic Tank Size Gals. t.� <br /> Addition . . . . . . Height Stories . . . . . . . . . . . . Pi i <br /> Sanitary . . . . . . Area . . . .. . . . . . . . . . . . . . . ]a.Absorption Field Site: S .L) rf <br /> Filling . . . . .. Soil Type <br /> Moving . . . . . . 5. Permits Required Slope .. . . .�p. . . ..,.._ . . . V :J i <br /> Grading . . . . . . Subdivision Per.. Rate <br /> Mobile Home . . . . . . Sanitary L/� Dry Well . . . . . . T q <br /> Privy . . . . . . Building .�� Seepage Trench . . . . . . m <br /> Well . . . . . . Well .�� Privy r� l <br /> Subdivision . . . . . . Other (Specify) . . . . . . Seepage Bed <br /> Conditional . . . . . . ;� nI <br /> 2. Classification Land Use . . . . . . n <br /> Zoning Dist. . . . . . . of <br /> B. Use (describe exectl 1 fam i <br /> 3. Lot Size home, motel,etc.l FOR COMMERCIAL USE <br /> 4q 0 <br /> .j. ,Q.9. . . it. x .L s-. ft. Plans Submitted . . . . . . <br /> .. . . . . . . . . . . . . . . . . sq. ft. Plans Approve(] . . . . . . I <br /> ------------------------------------------------------------------ <br /> Fig A. Location of proposed structures and r " <br /> existing structures, well, sewage sys r' i <br /> tems, roads, etc., should be sketched ,l <br /> / in Fig. A. Include road setback, side ii <br /> •W �•� CC Iy and back ya«1 dimension and location <br /> and setback from all bodies water. �l <br /> ❑I property is located a high <br /> way i <br /> �� y 'I `lerse<tion, show the intersecting high :JI .✓' <br /> /.� Ways and the setbacks required along— <br /> them and at the intersection. <br /> PERMIT FEES <br /> Subdivision . . . . . . . . . $15.00 !V <br /> Land Use . . . . . . . . . . 1.00 <br /> Building 5.00 <br /> Sanitary . . . . . . . . . . 10.00 <br /> Well 00 1 :T <br /> Septic Tank . . .k . . 1 1: 0 f-.J <br /> Combination Building, Sanitary `J . <br /> and Well _ 15.00 <br /> Privy . 5.00 <br /> a P <br /> Signature f Owner/or Agent�p/ f Date /,[%7iy in istramr <br /> Inspection Date �... .LZ.:..�L.. . ....... Inspector .. �G'ZCli!L.Z-r./. . �......._.... <br /> Remarks ( jl ...f .._4.�L!..c�!-Pfi`'.............._....... . ... .. r <br /> J. 71/� �¢ 1� ......................'..... <br /> .............._.... ......._......................... ......... ................ . ... ._..........................._................. ... ..... .. . .1. . ........ .. <br /> NOTE: A preliminary site inspection most be made and site approval granted on all structures involving sanitary f; <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be anai <br /> this application before a permit will be issued. Do not Purchase or install a septic tank, do any plumbing or start ani <br /> Ing unit a Permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyI <br /> with is found to exist. Changes in plans or specifications shall not be made without approval of the Zoning AdrniN <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVE <br /> r <br />