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Surnett'County Office of Zoning Administrator ` <br /> cn _V p —i Z <br /> 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a o <br /> Permit for the work described and located as shown herein. The undersigned agrees that all y <br /> work shall be done in accordance with the requirements of the County Zoning Ordinance, X" CD Il <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu- -v <br /> lations of the State of Wisconsin. <br /> 3 m :G— O <br /> 17L P�c <br /> ov".L),I.'//91 . . I . . . . . . . . . . . . . . . . . . . . e-, j . - <br /> Owner or Agent (please print) Contractor or SurvEyor y \ CD <br /> CD <br /> kJUn . �4 . . . . . 04-'r �.�+C. Wr. . . . . . . a <br /> Address Address a <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ' <br /> Phone Phone p� <br /> lt1. '.'l . . . ?. /c. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> ' Plumber Well Driller (� <br /> .N. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> Address Address <br /> O <br /> G� <br /> 0 <br /> 0 <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> Phone Phone CD <br /> o ° <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: <br /> Type of Construction No. Bathrooms ` o z 00 <br /> 1. Work . . . . . . . . . . . . . . . . . . . . . . No. Bedrooms ° <br /> CD <br /> New Building Size . . . . . ft. x . . . . . . ft. Septic Tank Size Gals. 7L% Z <br /> Addition . . . . . . Height . . . . . Stories . . . . . . . . . . . <br /> Sanitary /: . Area 7a.Absorption Field Site: :Ud <br /> Filling Soil Type . . . . . .3.4-. . o <br /> . . . . . 1 <br /> Moving . . . . . . 5. Permits Required Slope • • • • • • • •-"'•Z 3 <br /> Grading . . . . . . Subdivision Perc. Rate . . . . . . . . . . . . . . . . . , <br /> Mobile Home Sanitary r/ Dry Well . . . . . . CD CD <br /> Privy . . . . . . Building Seepage Trench ✓. `D `D <br /> Well . . . . . . Well Privy _ <br /> Subdivision . . . . . . Other (Specify) . . . . . . Seepage Bed . . . . . . o <br /> Conditional o �g N N <br /> CD <br /> 2. Classification Land Use . . . . . . <br /> Zoning Dist. . . . . . . sW o <br /> 6. Use (describe exactly, 1 -fam. <br /> 3. Lot Size home, motel, etc.) FOR COMMERCIAL USE 0 <br /> o <br /> /}ft. x . . . . . . . . ft. Plans Submitted . . . . . . � <br /> .-?�.7. . fT:4 nl s. . . sq. ft. Plans Approved . . . . . . <br /> ------------------------------------ tt <br /> Fig. A. Location of proposed structures and : t <br /> existing structures, well, sewage sys- o <br /> tems, roads, etc., should be sketched <br /> in Fig. A. Include road setback, side I <br /> and back yard dimension and location :� o <br /> and setback from all bodies of water. <br /> If property is located at a highway in8 <br /> - <br /> tersection, show the intersecting high- <br /> ways and the setbacks required along <br /> them and at the intersection. <br /> PERMIT FEES <br /> Subdivision..... $25.00 + $2.00 per lot. D <br /> Land Use................................. $10.00 <br /> Building................................... 10.00 C <br /> Sanitary .................................. 35. <br /> Well ........................................ 10.00 <br /> 5.00 <br /> Privy ....................................... <br /> 43>. <br /> __ 1 Vic' . ...... ............................ y,� . .. i.......... } ` su <br /> . ... ... ..... ..... ................................................. .......................... <br /> Signature of Owner or Agent ate Zoning Administrator <br /> InspectionDate ................................................ 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 />