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^.._ - � .. ll `• W� / tom <br /> Bo rnett County Office of Zoning Administrator Yp /ce o 1 z <br /> ' APPLICATION FOR SANITARY — LAND USE — BUILDINGPERMIT3 � <br /> -I 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 =Q <br /> work shall be done in accordance wiih the requirements of the County Zoning Ordinance, x- <br /> Sanitation Code, and with all other applicableCounty Ordinances and the laws and regu- v _ <br /> lotions of the State of Wisconsin. - <br /> /-.tiNO <br /> Owner or Agent (please print) - Contractce or Surveyor <br /> `,"/ j `ay -/G tQ A-✓2 So Jf2/�v,r.1,r . . . . . . . . . . . . . . a <br /> Address -' Address h � <br /> Phone Pho ie <br /> Plumber • S y0e Z Well Driller <br /> Address Address - Gs <br /> �� N <br /> Phone Pho e . . . . . . . . . . . . v r <br /> 0 <br /> DESCRIPTION 4 Bu ld n'IDe)ads 7. Sanitary Facilities: / - o 9 1 <br /> Type of ons v t No. Bathrooms <br /> 1. Wok - - . . No. Bedrooms <br /> . ^r y'J <br /> New &itl tg . �.. 5z .f ft. Septic Tank S' eGals. / J <br /> 0 <br /> z <br /> A <br /> Addition H in to -s <br /> Sanitary Area . . . 7acAbsorption Feld Site: <br /> Filling - Soil Type <br /> Moving 5. Permits Required Slope . <br /> MoorGradie Subdivision Pere Rale <br /> Mobile Home Sanitary Dry Well <br /> Privy Budding. Seepage Trench <br /> Well Well . . . . . . Privy v1' w <br /> Subdivision , .. . . . Other (Specify) _^ Seepage Bed 6/1.1AI <br /> Conditional <br /> - 2. Classification Land Use : . .-. . . . 1� I j <br /> Zoning Dist. . . . / <br /> ( �o. <br /> - 6 Us iea <br /> -3. Lot Si, ��k. homescr <br /> e motelbe,etxc.c)t) FORCOMMERCIAL USE <br /> 0/4 . .R. x . 7 6 . it, I Plans Submitted <br /> >osq T R Plans Approved - . . <br /> r K <br /> -- g A.Fi <br /> Location of proposed structures and <br /> - ex isiing structures, well, Sewage SyY 0 <br /> - Irons roads, etc., should be-sketched <br /> in Fig A Include road setback 5 1. <br /> - and back yard dimension and location <br /> and setback from all holies of water, <br /> J r� <br /> If property is located ata highway in <br /> [e rsec bon show the intersecting high <br /> �9 ways and the setbacks required along - V <br /> them a_nd at the intersection 's <br /> PERMIT FEES - " <br /> t <br /> ' <br /> Subdivision... .$25.00 + $2.00 per lot <br /> �i <br /> Land Use................................. $10.00' <br /> - - Building.....................:_........... '110.00 . ii- <br /> ' .. ' :. . ,_ Sanitary ..._............................. .20.00 _ = <br /> ' :• Sep Yc Tank 50000 , <br /> Priv .. 00 - <br /> Oto or Agent n D <br /> Inspection Date . ........................ . .... InspectnDate <br /> Si nature or <br /> Remarks <br /> �ffl <br /> ................. . ........-...-... .......... .. :........... .. • { <br /> ........ ...._.... ..... .� <br /> NOTE: A preliminary site inspection must be made and site -f P o al granted tall structures in.v;Iving sanitary facilities <br /> before construction can begin. In the case of sewerage disposal systems, a copy of thelpercolabon test must he attac�n�ed 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 Lound m exist- Changes in plans or specifications shall not be made without approval of the Zoning Adm inistratoo <br /> SEWER SYSTEM SHALL .NOT BE COVERED UNTIL INSPECTED By THIS OFFICE AND APPROVED. ' ~� <br />