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PP <br /> o o <br />\� t, ' . .eft County Office of Zoning Administrator 6 <br /> o <br /> \ APPLICATION FOR SANITARY = LAND USE — BUILDING PERMIT \� cct����., <br /> To the Zoning Administrator: The undersigned hereby makes application for 2 <br /> a Permit for the work described and located as shown herein. The undersigned agrees that <br /> all work shall be done in accordance with the requirements of the County Zoning Ordinanee, WH 0 <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regu: .v A y �j <br /> lations of the State of Wisconsin. :o <br /> ..E!'EiF677` ' S/Y!'yC GS I <br /> Owner or Agent (pllease print) Contractor or Surveyor [m �\ <br /> Address Pec.v/.rl z-« Address (� <br /> ...... ...... .... ... ........ ...... .. ......... .... ..... . . �C <br /> ......... .. .. <br /> Phone Phonetv- <br /> �N�.Ms....i..AG «...M..�' ... . . ........ ........ .... .... :...... . .. .. .. .'. <br /> Plumber Well Driller <br /> S o v. t... ... .W.1SsC- ..... s ' <br /> .... .... .... .... .... .... .... . ... . ....... e :'t . <br /> Address Address S :0 <br /> Y4,.s..9. 3el ........ ..... .... .. .. . ..... .... . ... .... . ..: ................. ... <br /> Phone Phone •R <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities _ <br /> I. Work (check one) 'type of Construction No. Bathrooms ... S <br /> Dishwasher <br /> New Building .. ... Y ' .... .�... <br /> Garbage Grinder <br /> AdditionSize G?.'f tt. x 'a?'f' ft. Autom. Laundry .Q... In <br /> Sanitary ..X... No. Bedrooms <br /> Alterations ...... Height Stories .... Waste Disposal <br /> Moving . .... . <br /> Wrecking ...... Area ... . System ..... . <br /> ....... .... ... Septic Tank Size ; <br /> Mobile Home ..... . 5. Permits Required 7,5...p y <br /> . ..... Gallons <br /> Privy Subdivision v <br /> Well X.. . Sanitary _✓ Absorption FSeld Sit? <br /> Building .. �. Soil Type S4.N.SS.... <br /> Subdivision . ..... 6 �• G <br /> well ...� slope ate ........ .. g L; <br /> Other (Specify) Pere. Rate <br /> 2. Classification - Y) ������ - Dry Well <br /> Zoning Dist. Condditional ... ... Seepage Trench <br /> Privy <br /> S. Lot Size 6. Use (describe exactly, I- Seepage Bed .... ... `� •\ y <br /> ' fam. home, motel, etc.) FOR COMMERCIAL USE <br /> 32.f... ft. x 3.2.(, ft. Plans Submitted . ..... z <br /> 1�iR?a �... ....'sq. ft. Plans Approved ...... p <br /> NOTE: A preliminary site inspection must be made and site approval granted on all strue. <br /> lures involving sanitary facilities before construction can begin. In the,case of sewerage dis- <br /> k}' <br /> posal systems, a copy of the percolation'test must be attached to this application before ap <br /> permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any B <br /> building until a permit has been issued. A permit may be'revoked if misrepresentation of <br /> any of the information conveyed herewith is found to exist. Changes in plans or specifics- ; t <br /> tions shall not be made without approval of the Zoning Administrator..SEWER SYSTEM �) <br /> SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE'AND APPROVED. <br />