020-638-13-4401-SAN-2021-397 - I'lease complete other side -
"As-Built Plot Plan"
Elevation Data
Benchmark � �-S Please include the followin�:
� Building Sewer �/'/ '�
.� Tank In '� � Location of observation and vent pipes
. Tank Out '�'8" � Feet of risers used on tank(s)
Dose Tank In � Location of bencl�unark and North arrow
Dose Tank 13ottom � Location of all components
Header or Manifold - Length of pipe between components
. Distribution Pipe � Number of chamber units in each cell
System Elevation � Location of well, lot lines and road
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Office of
Sawyer County Zoning and �����;:1�
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Conservation Administration �';;� —��r E��� � ,
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10610 Main Strcct, Suite 49 ��� �;M� ::`/ G^� ,�
Hayward, W I 54843
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'I�el:(71�)(34-8288 ,Z �1.��,� , ��� j� �
F'ax:(715)638-3277 G��i'1/���"'i�+ ��-�_ � �
URL: http://sa�vvercountv�ov.or� ��1y���;%LI�T�J '
EmaiL•zoninasec,ci sawyercountv��ov.or� STR,q�� `
7�011 Free:Courthouse/General Inforn�ation ��1/ �
1-877-699-4110
Sawyer County Zoning and Sanitation "As - Buitt" Form
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Property Uwner's Name � r 1 r�' ����'� � '
l-�ire Number and Road Name 7 �5� 1.J � �� 7 U
Plumber's Name ���'��'' S ����T�������
Date of Installation � r �'2 � �`�'
C:ounty Sanitary Pern�it Number "� � —� ? �
12 Digit Parcel Number ��� — � 3� �'"� � ��Y��
Description and Elevation of Benchmark I (.j� � � �"�� S��`�
Tank Manufact�n•er and Capacily Lt,a r5x% !�� �r��'n
Setback-"I'ank to Nearest Lot Line t ���
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Setback-Tank to Nearest Well
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Setback -"T�ank to Buildin� `f
Cell Width
Cell Length
Number of Cells _ _ _
Sctback - Cell ta Nearest Lot Line
Setback-Cell to Nearest Vb'ell
Setback - Cell to Building
Setback-Cell to Navisable Water
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Make and Model of Dispersal Unit
Make and Model of Filter
Make and Model of Pwnp _