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e2—" <br /> Office of Zoning Administrator W 8 c <br /> jATION FOR SANITARY — LAND USE — BUILDING PERMIT2. 3 u <br /> ,alr.G ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and <br /> >..-.,hcwn herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> L County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws ind <br /> Aliens of the State of Wisconsin. <br /> h. st ..... . �. ,.......................... . .......................................................................................... _ f <br /> OWNER I inti ass D m <br /> � _. CONTRACTOR or SURVEYOR or AGENT w � <br /> ...�� , <br /> ADDDE.. ......�t .. ...al. ..............s.......'. .................................................................................. ...... <br /> A <br /> RESSSS ;..... ADDRESS m . <br /> ��... . , ........ ..................................................................................... ...... <br /> ADDRESS .......... ................. ADDRESS (jj : <br /> ........................................................................................... . . . ..PHONE.......................................................................... ...... <br /> PHONE <br /> ........................................................................................... .W..EL.....L ....... <br /> ILL...ER.............................................................. ...... <br /> PLUMBER ...D..R <br /> ADDRESS ADDRESS m <br /> ........................................................................................... ..................................................................................... ...... O <br /> PHONE PHONE <br /> DESCRIPTION Z N r <br /> 4. Sanitary Facilities: ° o <br /> Y <br /> t• Wo \ ✓ 2. New Building Details No. Bathrooms ... ...... ' o — <br /> aw Type gf Construction: No. Bedrooms ... ...... <br /> j Jya I� Septic Tank Size Gals. ... <br /> Sanitary .......... S ...........T. ft. x .... ft. <br /> ize ' ... ...... <br /> . .�.... . , <br /> Filling/Grading .......... Height........... Stories ............... 4a. Absorption Field Site: � <br /> Moving Area ...................... Soil Type ............................. ...... <br /> .......... ..................... r- <br /> i <br /> 0, <br /> Mobile Home .......... Slope ................................... ...... <br /> Priv Pere. Rate ............................ ...... <br /> y <br /> Privy .......... 3. Use (describe exactly,'? -family <br /> Well ........ home,garage motel,etc.) y <br /> Dr Well ... ...... <br /> Subdivision ,,.,.,,,,, E Seepage Trench z <br /> ?. /.....:..:. .................. Priv K i <br /> CampingUnit ,,,-„ ,,,, <br /> : <br /> ............................... .................... Seepage Bed <br /> ... ..... <br /> — I N <br /> Location of proposed structures and existing structures, well sewage systems, roads, etc., should be sketched in Fi . A. <br /> Include road setback,side and backyard dimension and location and setback from all bodies of water. If property is local d at :� r� <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. — <br /> ——————————————————————————————————————————————————————————————————— — VJ <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... sq.ft. ....................................................................... ....... <br /> »e 0 <br /> I c \ <br /> X00 i$ ORs ” S <br /> w py c <br /> //ppll 1 O : <br /> PRo�' <br /> 0 <br /> �, y0.Rye <br /> 4- <br /> � <br /> N <br /> Z <br /> O <br /> �11/V 9 .m � mr Dmm <br /> 6 7 m cm m n c c <br /> A <br /> // m Na� '' nm ash <br /> 7 yd ' <br /> Q : <br /> a n o p <br /> G�`: ^�.......`L.1 t.� —............. .... ...�..3....I f i - o <br /> Signature of Owner or Agent Date g <br /> T : N <br /> m •� <br /> O <br /> O ' O <br /> Inspection Date ....................................... � N N O a T <br /> Zoning Administrat r <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this appli ation 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 issued. A permit may be <br /> revoked it misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or pecifications shall not be <br /> made without approval of the Zoning Administrator, <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND AP ROVED. <br />