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Buenet'ACounty Office of Zoning AdministratorCA o z <br /> CD CD d o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT -, CD <br /> ;v <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a H, (2. -14 <br /> Permit for the work described and located as shown herein. The undersigned agrees that all cD y <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- - °- <br /> gp <br /> lations of the State of Wis sin. o <br /> B d <br /> co <br /> co <br /> Own r or A nt ( lease print) Contractor r Sur yor H <br /> a <br /> Address Address a <br /> ......,sk <br /> Phone Phone <br /> Plumber Well Driller <br /> 0 <br /> Address Address C) <br /> 0 O <br /> c <br /> Phone Phone 0 0 <br /> CD o '' <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: -o <br /> Type of Construction No. Bathrooms Z z -oa ' <br /> 1. Work No. Bedrooms o <br /> New Building Size ft. x ft. Septic Tank Size Gals. N < <br /> Addition Height Stories <br /> 7a.Absorption Field Site: <br /> Sanitary Area r <br /> Filling Soil Type o <br /> Moving 5. Permits Required <br /> Slope r-+ <br /> Grading Subdivision Perc. Rate <br /> Mobile Home Sanitary Dry Well CD CD <br /> m T <br /> Privy Building Seepage Trench fD CD <br /> Well Seepage Bed oWell Privy `a fA <br /> Subdivision Other (Specify) o <br /> Conditional \ N N <br /> c a) <br /> 2. Classification ��^ Land Use 6 0 <br /> o <br /> Zoning Dist. < o <br /> 6. Use (describe exactly, 1 -fam. co <br /> 3. Lot Size home, motel,etc.) FOR COMMERCIAL USE 0' <br /> ft. x ft. Plans Submitted <br /> sq. ft. Plans Approved <br /> Fig. A. Location of proposed structures and -I <br /> existing structures, well, sewage sys- o <br /> tems, roads, etc., should be sketched n <br /> in Fig. A. Include road setback, side _= <br /> and back yard dimension and location <br /> and setback from all bodies of water. <br /> If property is located at a highway in- <br /> tersection, show the intersecting high <br /> Ci4 ways and the setbacks required along them and at the intersection. <br /> �� <br /> ,,,, ,0 P PERMIT FEES (0 <br /> Subdivision $25.00 + $2.00 per lot. <br /> co <br /> Land Use $10.00 \ <br /> Building 10.00 <br /> Sanitary 20.00 <br /> Well 10.00 <br /> Septic Tank 1 /...6": °r2 <br /> Privy 5.00 <br /> r <br /> ,.2.7 (/-c)- --i-F <br /> 1 <br /> Signature of Owner or Agent <br /> D e (//ádiistrator <br /> Inspection Date Inspector <br /> Remarks <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 he made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />