020-162-00-1301-SAN-2021-279 OfTice of
Sawyer County Zoning Administration :
PO I3ox 676 !t'J�
Hayward, WI 54843 0�' �'�
Tel:(715)634-8288 r.� ��%
Fax:(715)638-3277 S'�� � ��
• URL:http;//saw�rcoun ov.org 23 Z�? O
Email:zoning.sec�a sawvercountv o� S,q ?
' Toll Free:Courthouse/Cieneral Infonnation
1-877-F>9911110 ��N'��A��N/�UVTY
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Sawyer County Zoning and Sanitation "As - Built" Form
Property Owner's Name �(/�',r .;,✓��i R•✓
Fire Number and Road Name �17 4� �/ G� HwY Fi
Plumber's Name �U/_P U,�'j�r,,���
Date of Installation �' .� Z.
County Sanitary Permit Number .� 1 -.� 7 9
12 Digit Parcel Number �.� o/��o v/3 v o
Description and Elevation of Benchmark I�'�/'�apit 1�c i . / �
Tank MannfarhirPr anr�Cararitv �J S�24U✓
Setback-Tank to Nearest Lot Line _�0��
Setback-Tank to Nearest Well _,�...��
Setback-Tank to Building dL�
Cell Width _� `�
Cell Length ��._- � C2//1
Number of Cells �
Setback-Cell to Nearest Lot Line <SO �
Setback-Cell to Nearest Well �1 6 �
Setback-Cell to Building �
Setback- Cell to Navigable Water 0� �
Make and Model of Dispersal Unit ��p.l� ;�f us r� /�r c 1`
Make and Model of Filter �i Y�f�i M �t
Malce and Model of Pump �'
- Please complete other side -
"As-Built Plot Plan"
Elevation Data
Benchmark ,/ Please include the following:
� Building Sewer 9s.y
Tank In �N•� •Location of observation and vent pipes
Tank Out y y.� •Feet of risers used on tank(s)
Dose Tank In - •Location of benchmark and North arrow
Dose Tank Bottom ' •Location of all components
Header or Manifold •Length of pipe between components
Distribution Pipe �Number of chamber units in each cell
System Elevation ql.s'/yg,f' •Location of well,lot lines and road
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