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ed �Burieet C Unty - Office of Zoning Administrator �Ti9 C - <br /> Q � Z <br /> 0 0 <br /> �^'—"—=''APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT ' <br /> TO THE ZONING ADMINISTRAT_ OR: The undersigned hereby makes application for a y is <br /> Permit for the work described and -located as shown herein. The undersigned agrees that all' ' <br /> work shall he 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 rege <br /> lations of the State of Wisconsin. . <br /> Own�er or v. g <br /> //Agent (please print) - Contractor:or Surveyor • <br /> L•J Y U IJ �.Q (( L, 41! S ° , ° . . . . . . . . . <br /> f <br /> Address - Address - n <br /> Phone L Phone <br /> Plumber Well Driller [ <br /> Address ` Address: <br /> V o qV <br /> Phone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Phone D <br /> DESCRIPTION 4. Building Details 7, Sanitary Facilities. vn .�I. <br /> 0 <br /> _ Type of Consipi'ution -No. Bathrooms . .�. . . Z Z o <br /> ( f ry c z' 1 <br /> 1. Work . . . . . . . . . . . . . _ . . . . . . . Dishwasher <br /> New Building , . . . . . . Size . . . . . ft. x . . . . . . ft. Garbage Grinder . . . . . . <br /> Addition Height . . . Stories . . . . . Armour. Laundry <br /> Sanitary <� Area . . . No. Bedrooms cz-. . <br /> Alterations . . Waste Disposal System <br /> Moving . . 5r Permit, Required Septic Tank Size Gals. <br /> r <br /> Wrecking . . . . . . Subdivision . . . . . . Absorption Field Site <br /> Mobile Home . . . . . . Sanitary . . ±'. Soil Type vi x7 <br /> Privy . . . Building _ ° ° t <br /> . . .'. . . Slope . . . . . . . . . . . . . . .....'. . . m N i i ill <br /> Well . . :. . . Well . . . . . . Pere. Rate . . . . . . . . . <br /> Subdivision . . . . . . Other (Specify) . . . Dry Well YI <br /> 'Conditional . . . . .-. Seepage Trench r / . . . . . . - O > c, <br /> - 2. Classification _ Land . . . . . Privy J/y."X_l O c o <br /> Zoning Dist. . . . . . . Seepage Bed <br /> 6. Use ldescribeexactly l fallT[f�" M_ <br /> 3. Lot Size home,motel,etc.) FOR COMMERCIAL USE ° <br /> o . . . .:. . . . <br /> it. x . . . . . . . . f[. -Plans Submitted . . . . . . <br /> f7J�c;q.y- . . . . s4 f1. ` -Plans Approved . . . . . . :'� <br /> ________________--- ________________________________________ <br /> Location of proposed structures andv <br /> {') existing structures, well, sewage sys- �� o <br /> o\1 <br /> �\ toms, roads, etc., should be sketch ed <br /> in Fig. A. Include roadsetback, side <br /> and hackyard dimension and location �a <br /> - and setback from all bodies of water. .� <br /> If way <br /> pnd <br /> roperY <br /> ty is located at highway In- � <br /> tersectio n, show the intersecting high <br /> s7, ays athe setbacks required along <br /> them and a[ t <br /> 3Y he intersection. <br /> 0c <br /> PERMIT FEES <br /> Subdivision .- . . .. $15.00 <br /> Land Use . 1.00 . <br /> Building 5.00 !, <br /> •�SC� r - Sanitary . . . . . . . . . . . 10. <br /> 7 X S/�•> Well . . . . . . . 5.00 <br /> `anL,ac..mv.nf tI. .Septic Tank .- Im 'li.' .0 <br /> Combination B u i l d i n g, Sanitary V� <br /> and Well - 1.5.00 h` <br /> ' / n <br /> V . 777 .. ._ 4. ��og r <br /> Signature of Owner or Agent �D at � tiny Administrator <br /> r Inspection Dat ..-�%� ..... ... .... Inspector U��+'sfZ�?z�'.C(%.���G`C-z!'LF'C� . .._... .... <br /> Remarks \ 1. .�'-C.l.,[L-P_/-�:........ .__ .......... ... .._ <br /> ......:_.._...._.._....._..:.._......_....._........................................:................................................ ..............__..._......................... <br /> .. <br /> :..................................._...._..._......-............................................................................. ...................._......................_............. <br /> NOTE: A preliminary site inspection must be matte and site approval granted on all structures involving sanitary facilities <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached 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 maybe revoked if misrepresentation of any of the Informationconveyed here- <br /> with is found to exist. Changes in plans or specifications shall not he madewithout approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED: <br />