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i _ __ on Cory) F �:\_ <br /> "Bamalt County ,Office of Zoning Administrator -a O y <br /> APPLICATION FOR SANITARY — LAND USES BUILDING PERMIT = 3 ^a ``• <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a y o 'er <br /> Permit for the work described and located as shown herein. The undersigned agrees that all <br /> work shall be 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 regu. 9 e <br /> lat/i/9,ns of the State of Wisconsin. <br /> . !L. 4 . y b.C!'.* . . . . . dT. ecr. . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . — o <br /> 3 ? - <br /> Owner or Agent (please print) - V Contractor or Surveyor : r <br /> 3 3f '� 3ti AU. So• f � <br /> _ . . . . . ; � <br /> Address Address n <br /> ryr7PlS /N) i. 4 . SS If7 " <br /> Phone . . . . . . . . . . . . . . . . . . . . . . . . . .Phone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . m <br /> . . . . . _ . . _ <br /> Plumber- Well Driller <br /> . . . . . . . `` ` I <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . :N �A <br /> Address Address n <br /> U � o <br /> Phone Phone N1 <br /> A r � <br /> o <br /> _ o <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: v <br /> Type of Cons ctim, <br /> YI !zl No. Bathrooms <br /> Z o <br /> O o <br /> 1. Work Site ... . .. f 1:?. . SepNo. Bedrooms W E <br /> New Building . . . . . . Size . . . . . ft. x . �. . ft. Septic Tank Size Gals. . . . . � <br /> Addition _ . _ . Height . . . . . Stories . . . . q, <br /> Sanitary . .V Area 7a.Absorption field Site: 3�yy ), r'I <br /> Filling . . . . . . . . . . . . . . . . . . . . . . . . . Soil Type . . . . . . . . . . . . . . . . . . � n'J <br /> Moving . . . . . . 5. Permits Required Slope . . . . . . . . . . . . . . . . . . . . lltl <br /> Grading . . . . . . Subdivision Pare. Rate . . . . . . . . .. . . . . . <br /> Mobile Home . . . . . . Sanitary <br /> . .V. Dry Well <br /> Privy . . . . . . Building Seepage Trench <br /> Well . . . . Well , . . . . . Privy p an <br /> Seepage Bed I/,X.4.4 ? -I <br /> Subdivision . . . . . . Other (Specify) . . . . . . pO :O w w <br /> Conditional . . . . . . ( c <br /> 2. Classification Land Use . . . . . . <br /> Zoning Dist. . . . . . . y, 0 <br /> 6. Use (describe exactly( <br /> 3. Lot Size home,motel,etc.) FOR COMMERCIAL USE \N ° I <br /> . . . . . . . . .fft. x . . . . . . . . ft. Plans Submitted . . . . . . i oo a7r <br /> . . . . . . . . . . . . . . . . . . sq. ft. Plans Approved . . . . . . <br /> h 9 <br /> Fi <br /> SC Location of proposed structures and i � <br /> r1 existing structures, well, sewage sys _� o <br /> �6„ .—tem s, roads, etc., should be sketched $^ <br /> in Fig. A. Include road setback, side ii t s <br /> a KaQ end back yard dimension and location <br /> n <br /> and setback from all bodies ofwater. <br /> II �� If property is located at a highway in s �1 <br /> r3,a 1 tersetion, show the intersecting high <br /> I �—�{ If'1rJ4 wayscand the setbacks required along <br /> ' - JAadlr �J them and at the intersection. ?� <br /> a <br /> PERMIT FEES <br /> Subdivision . . . . . . . . $15.00 <br /> Land Use . . . . . . . . . . . 1.00 <br /> Tlliding—. . . . .(9 <br /> Sanitary 10.0 <br /> Well <br /> Septic Tank . . . . . 10.00 <br /> Combination Building, Sanitary <br /> and Well . . . . 15.00 <br /> Privy . . . . . . . . . . . . 5.00 <br /> .... ... .. . ��� ....... <br /> Signawre o9f Ownevbr Agent Date !/�f //Loot Administrator <br /> Inspection Date _.A.:.:.PF../... ..7.� Inspector ../ .��..�...... .........'C. - ..•......._........................ <br /> .. <br /> Remarks .5�..�r Z � �-� <br /> ..__................................................................................................_...........-. ............. <br /> ............._......................................—........................................._.'.. ........................................................._............ .............. <br /> ................................................................................................................................................................................................ <br /> NOTE: A preliminary site inspection must be made 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- I <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 found to exist. Changes in plans or specifications shall not be made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />