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,mQQtj GOURty - Office of Zoning Administrator tl^ <br /> d o o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <br /> 'ro lire ZONING ADMINISTRATOR: The undersigned fiereby"makes application for a <br /> Permit for the work described and located as shown herein. The undersigned agrees that all <br /> f work shall he done in accordance with the requirements of the County Zoning Ordinance, x <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- c, al <br /> la[/i Qyns of the State of Wisconsin. <br /> Own6rer Agent (please prjpttl Conu etor or Surveyor s^ <br /> .�. !�.l.ncelt.t>. . .". . . . . . . . . <br /> Aofdre . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . � � J <br /> Addrgss Address � <br /> p <br /> w.�. . . . . . . r9.( ��. . .).T . <br /> Phone Phone - - � <br /> . �. 3. . . . . . . . . . . ... . . <br /> Plumbe) Well Driller <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .'. . . . . . . . . . . . . . . . . . . . . .'. iV — . <br /> o <br /> Address Address iJ n' <br /> 0 111 <br /> Phone Phone n o � <br /> " o <br /> DESCRIPTION - 4. Building Details ]. Sanitary Facilities ni <br /> Type of Construction No. Bathrooms . . . . . . o o a <br /> 1. Work . . . �.C4"� . . . . . . Dishwasher <br /> New Budding Size. . <br /> 9.5+. ft. x .:�`� . ft. Garbage Grinder . . . . . . i +! <br /> Addition . . . . . . . Height . Stories . . . . .. Autom. Laundry - <br />_ Sanitary . . . . . . Area . . . .. . . . . . .. . . . . . . . No. Bedrooms <br /> Alterations . . . . . . Waste Disposal System <br /> J e <br /> Moving . . . . . . 5. Permits Required - Septic Tank Size Gals. `/.-5. . . <br /> Wrecking . _t. . Subdivision . . . . . . Absorption Field Site - <br /> T m <br /> Mobile Home . . . . . . Sanitary . 4� Soil Type '.4.`:'.`. . . . . . . . . . - :� <br /> Privy . . . . . . Building Slope. . . . . . . . . . . . . . . . of <br /> Well . . . . . . Well Pere. Rate .--r4 <br /> Subdivision . . . . . . Other (Specify) . . . . . . Dry Well . . . . . . U-)' ' <br /> Conditional . . . . . . Seepage Trench . . . . . . iO. `c of <br /> 2. Classification Land . . . . . . Privy .� .Q -a <br /> Zoning Dist . . . . . . Seepage Bed �� 7� ✓ ° 0 <br /> 6. Use (describe exactl <br /> 3. Lot Size home,motel,etc.) FOR COMMERCIAL USE ° <br /> ft. x . . . . . . . . ft. Plans Submitted . . . . . . I <br /> . . . . ) <br /> .t.. . . . . . . . . . . s4 (t. Plans Approved <br /> . . i <br /> ------------------p----- -----'--------(- --------------- <br /> Fig. <br /> D� A. Location of proposed',structures and _ <br /> Ibrq� ��------_—_ <br /> existing structures, well, sewage�sy s-. �� i o� <br /> �I I <br /> terns, roads, etc., should be sketched E I <br /> in Fig. A. Include road setback, side s� <br /> n - _ and back yard dimension and location la <br /> t and setback from all bodies of water. <br /> If Property is located at a highway in- <br /> tersection, <br /> n- <br /> tersection, show the in ieifire y high- <br /> ways and the setbacks le4ge ued-a long. <br /> 5 <br /> them and at the intersection. <br /> Q PERMIT FEES <br /> - Subdivision . . . . . . 515.00 <br /> ]J Land Use . .. . -. 1.00t <br /> Building .<\ 5.00 <br /> �x Sanitary . . . . . . 10 00 R�1 <br /> 1 ! Well . . . . . . �,5_p i .. <br /> Septic Tank . . . . . ,000 _ <br /> Combination Building, Sanitary <br /> J'— and Well . . . . . . . . 5.00i <br /> Signa <br /> lure of Owgerr'Jor Agenptt yy. Date y�/� Z ,Din/y Ftlrtl 1p istrator <br /> Inspection Date(, ,t1r(. ......Lf..2../........ Inspector .....L�Lfrl/...:LGX��:..L�/U. •..................._• <br /> Rem rkP../...`..w_._....... <br /> ..................... ....._..... .. . - <br /> �... <br /> . . ...�L�! .".�fi...Cnc�........L�Gtr�� C%Zf.T <br /> ... .................:............................... <br /> NOTE: A preliminary site inspection must be made and site approval granted onall structures involving sanitary faciliti <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached] <br /> this application Delete a perm❑ will he issued. Do not Purchase or install a septic tank, do any plumbing or start any buil <br /> ing until a permit has been issued. A permit may be revoked if misrepre sen talion of any of the information conveyed hes <br /> with is found to exist. Changes in plans or specifications shall not be made without approval of the Zoning Administrant! <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. I <br />