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• 'r, Office of Zoning Administrator Ln A o 0 <br /> I_. °tttiD Se, fcn710N7E0R SANITARY — LAND USE — BUILDING PERMIT 3 <br /> 9 _ g o <br /> TO THE ZONING ADM IN sTn A'lon' 11 �inaeri4rrN nereuv 'Trak..realization her a Permit for the work described and located as <br /> .r. , hit The Lntlursigned egreei that all work Shell has done in ar—mr nca with the a(krl"Tay'ta of rhe Bu.nett County Land Useas <br /> 10"ime ce., Bar i mlion Cmde,an '-,fill all other appleMble County Ordinances and the laws and regulations of the Slate of Wisconsin. _ (� <br /> .Czo 1,.Q... ..........wl.'J.Jiv................................ ......_..............................._-- 3 al I o <br /> r al <br /> OWNER Ipleas�printl CONTRACTOR or SURVEYOR or AGENT <br /> /�..D ......A. <br /> .....W1.4 rn r <br /> ....I/..............__s.:............. ...................... ........ ........................................................_.. <br /> ri��rREss arDREss <br /> 7 <br /> .... .I.�C'..c.......Lz9. e........±-�.!...........J:..y..dG_S.' . ............ -.......................................................................... �•� N L <br /> ADDRESS ADDRESS <br /> PHONE PHONE <br /> PP� ........................................... ............................................................................................ N <br /> dBER WELL DRILLER N <br /> P r <br /> ADDRESS ADDRESS r <br /> c <br /> . . . . ....................�U.SJ ^^ ... .. <br /> o _ <br /> ........................................................................................... V....L.S........................................ c o <br /> PHONE PHDNE I � 2 N o <br /> DESCRIPTION 4. Sanitary Facilities: er 2 .0 d <br /> 1. Work: No. Bathrooms 7 :O <br /> 2. New Building Details """" <br /> No.Bedrooms o <br /> New Building .......... Type of Construction: - <br /> Septic Tank Size Gals. <br /> ........ '� .- <br /> Addition _._..... .........._............................. <br /> i <br /> Sanitary ..JLC... Size ............ ft.x ..... ,....... ft ✓"S" u <br /> 4a. Absorption Field Site: 1' I(I <br /> Filling .......... Height............. Stories............... l i0 <br /> MMovie .......... Area Soil Type .................................... ` ' r <br /> otion .......................................Y <br /> Grading .. .. Slope .......................................... <br /> ... .. <br /> Mobile Home Rare. Rate ................................... <br /> .......... 3. Use edescribe enrol ..1 . famil ) '� <br /> Dry Well <br /> Privy .......... home,garage,motel, e .) :70 <br /> Well Seepage Trench ..... Rj :G I <br /> Subdivision .......... .......... ............ n <br /> Privy <br /> ......................._.- Seepage Bedfar <br /> - <br /> Location of proposed structures antl existing structures well sewage systems,roads an,,should Ue sketchM in Fig A. Include road I .P <br /> Setback, side and bock yrnl d'unereion and location and setback from all bodies of wrier. If property is located at a higtwoy tater- a IT) I <br /> section, show the intersecting highways and the setbacks requirall along them and at the intersection. CLEARLY LABEL EXISTING l! iy Z <br /> r <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o <br /> -------------------------------------------------------------------- <br /> 5. t Size: Fig. A. 6. Location: be I <br /> �Q R <br /> .V.Ur.�..... ft. xft. - ............................... s9.ft. ............................................................ .............. <br /> .._ :I t <br /> M ? ce I <br /> O <br /> O <br /> `iU <br /> O <br /> 1 r " try <br /> ` T .o Q <br /> }�xi <br /> t</i as <br /> c <br /> r, tirv� m <br /> a on e m < � ; tC <br /> de <br /> to <br /> !e\Vo� E`ii <br /> Signature of Owner Agent Date- ;X <br /> Remarks ........................................................... <br /> .........................._...._.......................................................................... <br /> . A <br /> as <br /> ............._.......... ............................ <br /> ............................................................................................................... ...... N 1 <br /> Inspection Date ....................................... ' CLC. -'�... tl u ^0 0 o <br /> Zoning Ad ¢trator 0 0 0 0 <br /> NOTE: A preliminary site inspection oust be made and Site :n.pruval granted on all structures involving sanitnvy facilito <br /> before construction can begin. In the case of sewerrge disposid syslCats, a copy of tilt: pmcoletion test muv be attached 1 <br /> this application before a permit will be issued. Do not pmehase or install a septic lank, do any plumbing or scut any bdil <br /> Ing until a permit has been issued_ A permit may be revoked it miSrepresentatilen of amy OI the I,,to...Jllnn Louseyef h�" <br /> with is found to exist. Changes in Plans or specifications shall not be made without approval of the Zoning Adn.inisoalc <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. I <br />