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G Office of Zoning Administrator <br /> Bu7hettaCGunty a o z <br /> 0 0 <br /> If APPLICAI ION FOR SANITARY — LAND USE BUILDING PER <br /> tTO THE ZONING ADMINISTRATOR: The undersigned hereby makes application 10, a `k o <br /> ( Permit for lire work describd ed and locateas 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 <br /> rations of the State of Wisconsin. 3 c ` a O <br /> Rev. IRobert Oberoinder - ch i <br /> - 1 <br /> owner or Agent (please prinll COnvactur or Surveyor <br /> VVJ 3 ° <br /> Rt. 2 <br /> a <br /> Addle . . . . . . . . . . . . . . . . . . u <br /> Addle Address n <br /> - Danbury , WZ• 54830 - .0 <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . — \ o <br /> Phone I 'Phonefla <br /> ip <br /> Donald Daniels �� ; :•s <br /> . . . . . . . <br /> Plumber Well Driller <br /> Box�W Siren, WI 54872 F :W o <br /> Address . . . <br /> . . . . .Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iJ ° <br /> 463-?333 . or 349-5364 o -r <br /> Phone I . . . . . . . . . . . . . .Phone <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: a �n ?' <br /> Type of Construction No. Bathrooms . . .} o z <br /> 1. Work I . . . . . . . . . . . . . . . . . . . . . . . No. Bedrooms . . .3 . . r,. o <br /> New Building . . . . . . Size . . . . . ft. x . . . . . . It. Septic Tank Site Gals. :`� ;'�Zi t <br /> Adds 7000 <br /> Addition . . . . . . Height . . . . . Stories.. . . . . . -X. Area ]a.Absorption Field Site: <br /> Sanitary . . . . t <br /> ' Soil Type <br /> Filling . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . <br /> Moving . . . . . . -5. Permits Required Slope . . . . . . . . . . . . . . . . . . . . '}} p <br /> Grading . . . . . . Subdivision . . . Perc. Rate - . . . . . . . 2. .2. .2. . . x <br /> Mobile Home Sanitary Dry Well . . . . . . <br /> Privy, . . . . . . Building . . . . . . Seepage Trench . . . . . . Al "t <br /> Well . . Well . . . .. Privy . . . . . . ED <br /> Subdivision . . . . . . . Other (Specify) . . . . . . Seepage Bed g <br /> Conditional �� �' <br /> u <br /> 2. Classification Land Use . . . . . . J 2't <br /> ,. <br /> pqct_ <br /> Zoning Disc. �. ✓ � �.'1 E;2� 6. Use (describe exactly, 1 -fam. 1 : o _v)_ , <br /> 3. Lott Size home, motel, etc.) FOR COMMERCIAL USE <br /> . . . . . . ft. x . . . . . . . . ft Plans Submitted . . . . . . w .� p <br /> . . .L . . . .. . .. . . . . . . sq. fl. Single family home Plans Approved . . . . . . <br /> ------ ---------------------------------------------------------- O <br /> Fig. A. Location of proposed structures and `�� � ' <br /> N ' <br /> existing structures, well, sewage Sys 9l: <br /> Curs, roads, etc., should be sketched D� i <br /> in Fig. A. Include road setback, side <br /> and back yard dimension and location <br /> and setback from all bodies of water. i G a <br /> If property is located at a highway in <br /> i T i at, <br /> 0 <br /> trisection, show the into rsc cling high Com' <br /> ways and the setbacks required along <br /> Them and at the intersection. <br /> 0 <br /> PERMIT FEES <br /> Subdivision.....525.00 + $2.00 per lot. E <br /> Land Use................................. $10.00 <br /> Building <br /> ................... ............... 10.00 <br /> Well ........................................ 10.00 <br /> Septic Tank .....................'...... 10.00 <br /> a ...%% 2- 3 <br /> Signature of Owner or Agent Date � Zoning A< minist razor <br /> Inspection Date ............ .. .. ... Inspector ........................... <br /> - ..... <br /> /? .. <br /> I........ .. Remarks .r R& ..a �-a r,.rr!/.l7JCeE� ..Se.x.e . �' �. ..7� <br /> f ... <br /> :.....il...:._...................................................._........._............_........._......................1-1......... .................. <br /> NOTE: A preliminary site inspection most be made and site approval granted on all structures involving sanitary facili <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attache( <br /> thislapplication before a permit will be issued. Do not purchase or install a septic lank, do any plumbing orstart any ba <br /> me ynnl a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed'h <br /> with is found to exist. Changes in plans or specifications shall not be made without approval of the Zoning Administra <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED. BY THIS OFFICE AND APPROVED.- <br />