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'f ,{ Office of Zoning Administrator <br /> Buin`tt'County /� /� 0 0 <br /> I •TYAPPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a <br /> Permit for the work described and located as shown herein. The undersigned agrees that all o'c <br /> work shall be done in accordance with the requirements of the County Zoning Ordinance, n \ <br /> I Sanitation Code, and with all other applicable County Ordinances and the laws and regi no a : <br /> t lations of the State of Wisconsin. {{{ O <br /> �EILNH2 3 <br /> A. . .GQ N VIER. . . . . . . . . . . . . . . . . . . .o. = <br /> d <br /> Owner or Agent (please print) Contractor r Surveyor N <br /> . . . . ... . . . . . . . . . . . . . . . . . . <br /> `f�\y <br /> Address Address <br /> n i\ :X, <br /> u �� <br /> C•l2 9z9 n.s.SY. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> Phone)J Phone <br /> . . . . . . . . . . . . . . . . . . . <br /> Plonneber Well Driller C ! <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> Addre. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _ V <br /> Address Ass <br /> zi o <br /> i <br /> I � N. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> Phone <br /> r <br /> Phone Phone <br /> ' . . . o' ' i <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: v � I <br /> Type/ofzo�+� action No. Bathrooms o \ I <br /> 1. Work . 4JNo. Bedrooms <br /> New Building . . . . . . Size y///�'f/Jx . . . . . . ft. Septic Tank Size Gals. <br /> Addition Height . . . .-. Stories . . . . . . . . . . . . 1 i+ <br /> Sanitary Area .� . . . . . . . . . . . . 7a.Absorp[ion Field <br /> Filling . . . . . . . . . . . . Soil Type . . . . . . . o <br /> Moving . . . . . . 5. Permits Required slope . . . . . . . . �? <br /> Grading . . . . . . Subdivision Pere. Rate . . -3.1'3. . . . . r m <br /> Mobile Home . . . . . . Sanitary . . {/ Dry Well . . . . . . ° !V\ <br /> Privy . . . . . . Building , , . . . . Seepage Trench . . . . . . � I <br /> Well . . . . . . Well . . . . . . Privy . . . . . . �' <br /> n <br /> Seepage Bed AZG y 3>=p•• O ' <br /> Subtlivision Other (Specify) . . . . . . ° " 6 <br /> Conditional . . . . . . `o <br /> 2. Classification Land Use . . . . . . <br /> 0 <br /> Zoning Dist. <br /> B. Use describe exact) 17fam. `�'' <br /> 3. Lot Sizehote ,etc. <br /> ome, l ) FOR COMMERCIAL USE <br /> �� <br /> Q-G ft. x . . ft. Plans Submitted <br /> _:S 4.fC0� . . . . sq ft Plans Approved <br /> _______________________________ __________________--15 -------------- <br /> (Fig <br /> -15(Fig A. Location of proposed structures and 'V <br /> existing structures, well, sewage sys- I o <br /> gems, roads, etc., should be sketched <br /> �( y�ze./ in Fig. A. Include road setback' side <br /> and back yard dimension and location <br /> / pp <br /> Ce- te nd setback from all bodies of water.If operty is located at a highway intersection, show the Intersecting high <br /> \ z p6 QZ� T ways and the setbacks required along <br /> H them and at the intersection. i <br /> a <br /> y°�k Iyy [Ire PERMIT FEES <br /> ^►� <br /> Subdivision.....$25.00 + $2.00 per lot \ <br /> r! Land Use-............................... $10.00 Q <br /> Building................................... .10.00 <br /> Sanitary .................................. 20.00 <br /> Well ........................................ 10.00 <br /> Septic Tank ............................ 10.00 <br /> Privy ....................................... 5.00 <br /> f <br /> Pmt T Ly-Ic it <br /> �� . . <br /> . 1 ; ._9.U......,.a....C./..-.O...'.".(..."../.y..2.._/..........r/. . .. .r. <br /> ........... .�..................... . ......... <br /> ................... <br /> ......,......... .. <br /> gntOor r Agent / Zoning Admiew,a or <br /> Inspection Date / ..._.... .... Inspector 16�� p <br /> Remarks // bC .. .. ............. . ........ l <br /> .. <br /> �z!�...!.. .... ./ U.�.,.,.,./.{Z'.0 4�nl�e._ Oiz- �.. _//' .. - ......... <br /> . 7; .. <br /> /re <br /> Ua ? ! F:.._1 /......._._s.... .. ...,.. <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary fadi`it ie <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attachedlb <br /> this application before a permit will be issued. Do not purchase or install a septic iarl do any plumbing or start any buil <br /> ung until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed heri <br /> with is found to exist. Changes in plans or specifications shall not be made without approval of the Zoning Administrate <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />