Laserfiche WebLink
B_ui;natt County Office of Zoning Administrator o z <br />APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 o <br />TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a 0 <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,CD <br />Sanitation Code, and with all other applicable County Ordinances and the laws and regu- <br />lations of the State of Wisconsin. 3 a :(� <br />°; <br />a <br />Owner or Agent (please print) %A Contractor or Surveyor <br />0_ <br />Address Address <br />CD <br />\ ;S <br />Phone Phone t <br />. `� tom•: � .. �' <br />Plumber ..5.�1... �..............Driller............................. • <br />( Well <br />r <br />� <br />n 0�u.«,..... <br />Address Address <br />\1 <br />0 ................... <br />.................................... <br />Phone Phone C y r- cr <br />0 ° tl' <br />0 r' <br />DESCRIPTION 4. Building Details 7. Sanitary Facilities: -° <br />Type of Construction No. Bathrooms • • • • • • o z 0 <br />1. Work.......NoBedrooms ° <br />. CD <br />New Building Size .x.. ft. x . << O . f . Septic Tank Size Gals. r%�O <br />Addition .. Height ... Stories <br />.. Area < ........(r'!7a.Absorption Field,Sit�y:� \ <br />Sanitary 1:7L? C ` <br />Filling Soil Type r ... ..... \` 0 <br />Moving 5. Permits Required Slope _?©............ <br />Grading ...... Subdivision • . • • , , Perc. Rate ...3............. <br />Mobile Home SanitaryVic... Dry Well m CD <br />Privy ...... Building Seepage Trench ...... `D `D <br />Well...... Privy <br />...... Well ..... .� <br />Subdivision ...... Other (Specify) ...... Seepage Bed <br />Conditional cn cn <br />CD <br />2. Classification Land Use G o <br />Zoning Dist. ...... ^ t ; ° o' <br />6. Use (describe exactly, 1� fam. <br />3. Lot Size home, motel, etc.) FOR COMMERCIAL USE ° <br />. ft. x ...... ft. Plans Submitted ...... <br />_-. y'6.�Esq. ft. Plans Approved <br />-------------�1 CiLC,----------------------------------------- <br />Fig. A. Location of proposed structures and <br />existing structures, well, sewage sys- <br />tems, roads, etc., should be sketched � <br />0 <br />in Fig. A. Include road setback, side I 3 <br />Q I and back yard dimension and location <br />V <br />L._.j and setback from all bodies of water. <br />If property is located at a highway in- ` <br />tersection, show the intersecting high- <br />ways and the setbacks required along •11 <br />4C' them and at the intersection. <br />PERMIT FEES <br />ISubdivision . . . . . . . . . $15.00 fD <br />Land Use . . . . . . . . . 1.00 <br />Building . . . . . . . 5.00 .� <br />Sanitary . . . . . . 10.00 u <br />Well . . . . . . . . . . . 5.00 <br />Septic Tank .k . 100 <br />Combination Building, Sanitary f <br />o and Well . . . . . . . . 15.00 r <br />J' Privy . . . . . . . . . . . . 5.00 . <br />11 <br />........ <br />... n........... <br />�.�...:....................... <br />Signature of Ower o Agent Date Zoning Administrator <br />Inspection Date ..................W,4io <br />- Inspector................................................................................................ <br />Remarks.............................................. <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- <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 />