002-121-15-1500-LUP-1989-340 , 11pp1icaLioii Lor Land Use Permit �
County of Sawyer �
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7't�e undersigned hereby makes application for a Land Use Permit and agrees �
that all work shall be done in accordance v,ith tlie requirements of the Sawyer ;;,
County Zoning Ordinance �nd t}�e laws and regulations of the St1te of Wi�c�nsin. ,
PRINT - USE ONLY BLACK INK/PLNCIL
�lY1e�'�_�t� �. ��r��i� u
u
A�ber}ir� �'o,rnes }�-�. E}Ux Fratnk Ca�r �.
Owner Builder p
1��. � �ox 213 3 �
�.�4. 5 3G x Szoq `0
mailing address mailing address
ITayWArc,�, �11 5�{'843 �0�4WAr� yV1 5�84�3
city, state, zip city, tate, zip
Building Land Use Zone District .
(�-J New ( ) P'illing
( ) Addition � ��
( ) Dredging Lot size ((�� ,_ �';'� ' rr �
( ) Alteration ( ) Grading �, ,R.,'
( ) Moving on ( ) ncres , �-�3
( a- ,. : r {., '� ( )
N �
New Construction + f�
�
Size 2.� ft wide ft wide �
� s-
32. ft lo�ig ft long C �
Floor area 7(qg sq ft sq ft �
� �
Total hgt � to peak to peak x �
Stories � m
Ui -�-
fi
No. of bedrooms � - ' rear lot line or waterline
, - . �_.,�� ;
(year round) or (seasoiial)
� � ';
Type of bldg or addition �
i � ' �
( ) Dwelli�lg �':•� 34� � G ��-+
(x) Garage (1) 2) car � __�__ � �
O Storage building i - --"" - � f a r
i r• O
( ) Boathouse i �- .�';• --�i �• rt
( ) Livingroom i ��' � �' l,.`i i r�
( ) Bedroom 4-- -> ���5' ����, i o
i :,��,�e i
( ) Kitchen-dining i � ii n
( ) Porch - enclosed/roofed � � -- � • o
O Deck - open i 1 i ; �
O i i M
( ) i � :
� �
, , ,
' ' � I or
Type of construction �
i -> ¢
(� Frame ( ) Block �` i '- ?- ` � i
( ) Lo9 - ( ) Coiicrete � �Oi '��_ '�=1-' i
O Pole � ) Steel � i i�* � i_ _ __ � i
( ) Metal � � �i�t � i ••� i c �-
_i n��`"� � �' i i�
i u, #-.,__� , ' i ! �n
Construction cost � �� - - �� � t' N �
$ 00. � '� � _ ���=->-�. , �
it+� ���i' � i 1 !",
Vol �<��`=, P9 4.`� of deed � �. - i _ G!
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' � �
CSM Vol Pg � � i ro
i N i a
i
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Cer. Soil Test �� -��� i � z � i n �
w � �
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Sanitary Permit �� - I � ----------CL road ------------------- o
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Issued �� �p����,ry���, (��j� Denied �
# �I�Q�t�t�t�� �—�G 2�7 � o
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� — �� ur� �, —
owner Zoning Administiator O N
��y
(�, SANITARY PERMIT APPLICATION �°�"T''- -- -- - - �
��� LI �ILHR SAWYER . c
In accord with ILHR 83.05,Wis. Adm. Code STATF SANITARY PERMIT# ►
--1 C
CST 88-177 114437 �
Attach complete plans (to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER '
8Yz x 11 inches in size.
See reverse side for instructions for completing this application. pE7i7ioN
APPUCANT INFORMATION-PLEASE PRINT ALL INFORMATION. Foct vARi/+NCE �vES D No
- —_ _ _ _ ___ _
_ ----- ---
ROPERTY OWNER PROPERTY LOCATIUN
Ja M �s .4 �6ci-�..� - �/4 - Y4, g 3�p T 4p, N, R 8 (or) W
—__ -- _ __------
__ - --
NOPERTY OWNER'S MAILING ADDRESS LOT NUMQER BLOCK NUMBER SUB IVI ION NAMF� � S-��/,
o woc�ds c c�
�� .Z, �o x -2-/3-3 /S-ZO �S ���n�+tu n: �j�zcl� _/Sdd•_
_ _- -- -
11�/STATE ZIPCODE PHONE NUMBEH CITY NPAitFS(ROl�D,IAKE OR LAhDMARK
h•2Yw t� kf/ S�B Sl3 I VILLAGE : B.7.sS �z�4. (�/u�Ie nc� •�✓�, .
I. TYPE 04 BUlLDING OH USE SERVED:
Jumber of Bedrooms ii 1 or 2 Famil �N� �� OR �_-� Public (Specify):
Y- -��-yv�d�------
-�-�-�-�•r
II. PURPOSE OF APPLICATION: (Check oniy one in#1. Check#2,3 or 4,if applicable)
� �( r� �� Repair of an
1. a. �_l New b. �Tl'Fieplacement c. LJ Replacement of d. �_ � Reconnection of e.
System System Septic Tank Only an Existing System Existing System
2. ❑ A Sanitary Permit was previously issued. Permit# Date Issued _ _ ______ __ _ _ _ _
3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements.
4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Cop�.
V. TYPE OF SYSTEM: (Check only one in#1 and only one in#2)
1. a. �Conventional b. � Alternative c. ❑ Experimental
2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP
In-Fill 1-ank
V. ABSORPTION SYSTEM INFORMATION: (Check one)
1. a. _ Seepa�c e Bed b. ❑See a e Trench c. ❑ Se�a�Pit __ _ __ __.____ __________ ___—___—_-
� PERCOLATION RATE 3. ABSORPTION AREA 4 ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: ,
(Minutes per inch� REQUIRED(Squar Fee): PROPOSED(Square Feet) �1 �
�/6 ,�oS �y/�� 3 70 ���� 9.S•g� Feet �Private I-1 Joint �J Public
' CAPACITY Site
YI. TANK �n allons Total #of Prefab. Fiber- Exper.
�- - Manufacturer's Name Concrete Con- Steel 9�ass Plastic APp
INFORMATION New xistfng Gallons Tanks structed
Tanks Tanks -- - ----
----- -� ❑ ❑ ❑
------ - — �� � �
-- - --- o � ���.ss�
�e Up c Tank or Holdin Tank _ � _ - --(� - n
itt Pum Tank/Si hon Chamber u `�' � � � ❑
Vil. RESPONSIBILITY STATEMENT
I,the undersigned,assume responsibility for instailation of the private sewage system shown on the attached plans.
�lumber's Name(Print P�umber's Signature:( Stamps) MP/MPRSW No.: Business Phone Number
,4,�o�c y ��,�.,Uss�/ 3y3� �_7�s � 7y��%�3ss
'lun:ber's Address(Street,Cily,State,Zip Code) `�- ------------ Name of Designer'
��,�67C le�v C'•�B t.�-� /�..// SSl� z� ����v�s �.Lc'.�.uss�--n/
JIlI. SOIL TEST INFORMATION ____ _ _ _ __ _ _
_ _- —---- -- _ _ _
- - ------ -- CS7#
ertified Soil Tester(CST) 3me 43��
Dc-�//✓�-s �bf'/`-f L!S 1'c'�
--- --- --- _- __ _
:ST's ADDRESS(Street,City,State,7_ip CodeL, I Phone Number: �
/�T• �� �a X /li � �AB�'j �/ S��z--/ � ( ?/S ) 79'�-3T��
PARTMENT USE ONLY j
IX. COUNTYID� — -—
----- — _
-- ----- —- _
i�I D�sapproved Sanitary Permit Fee Groundwater ate Iss�mg Agent Signature(No Stamps) I
SurchargeFce
�� A������ed C] oW�e�G��e�i��t�di $90 . 00 $25 . 00 9-12-88 �
Adverse Detenninntion'
X. COMMEPITS/REASONS FOR DISAPPROVAL: '
F�D-6398((ormerly Pib-67)(R.03/8G) DiSTRIBUTION: Original to Counry,One Copy To:Bureau of Plumbing,Owner,Plumber
DEPARTMFNT uF INDUSTf?1 INSPECTION REPORT FOR SAFETY&BUILDING .
` I AI30R'8 HUMAN RFI ATIt�"i'. DIVISION
,,�, ��h ;�,,;,, ON-SITE SEWAGE SYSTEMS u�F�ci uf r�ivisioN cooFs x nPr�ucnTioN
Pv"ADISON \1'I 53��% StateP�anl.D Number
�CONVENTIONAL �,-�1 ALTERATNE Ofassigned) •
I Holding Tank � � In-Ground f'ressurc � � Mound
-_ ---
� i i�,, �, � �i,-�. -^�:;� - � ���ADDRESSOFPERMITHOIDER� - INSPECTIONDATE'
R, ., � E �-r�r� _�_�--�.a �x �t33_ �Y�R� 9 -(a-
� M�s l� e� _ _ _----,-- --
i i .....hi �..,�..... ,... . � . ��. �. . :��k I�fli�FFRt NT FRO�v1 P,�N �RFF Pi FI EV.-.� CST RFF 'i FLE�/.�
Cov�.� w E�� p �T loo
- -- - - - . - - - __ _ - -- --
-,,,�,., ,i{�.,,,., A1P ti V HSW Nn �C ��y Sanitary'ermrt NUmber
I
ANORY R�s�vss��l _ 3�38 _L - - -- - __-- 88_�6s�i� u437
�; 7iC TANK/NOLDING TANK:
_ _ ___ - I --
�.� � i��, �,, ��- �- � � � � � —��IC �,�F 4C�1� TANK!N�.�1 E I J IANK OUTI ET ELEV- WARNING LABEL �UCKING COV��
Q q PHOVIDED�. HOVIDED�.
9�RS�`1 VSS E� I a DD i ! �• S ; r 7 • � �YES_O NO CJ YES C)NO
, . ��i ' � �� I �YE�Tf H �� NUMBER OF � -��'�- � �F RUPERTY WFI L� � BUILDING VtNT TO�RESH
r .� u,;. �•, _• • r,i�r{wn
� � IINF � � AIRINLEi�
�li , „nRM � FEET FROM � /
I, _YES l_1 S L;NO I NEAftEST--�� � bO > �O ?�
_ _ — --- -- --- -- �S
DOSING CHAMBER: _
„ -- P�vYES ❑NO PCR,° ----
..---- JOW�, .�.�.�I;; ,�,ii1 PIIMPMODCi 11'liMl'/SIPHONf - ------ ,KINGGOVfR
.�� � �', ��I%��.�Uftt R WnRNINU LABEL �"U�,JIDED�. 1
ALL ONSFPFiR CY`Cl�YE S ..;NO 1 rpUMP AND COhTROI S OPERATIONl�.I� NUMBER OF PHOPERTY WELL- BUILDING YES CJ NO
— . .. -_— __._ _
U E- �. VENT TO FRFSH
�f)IFF FHFNCf E3E i Wf f N � FEET FROn1 ��NF nia wi Er
PUMP ON AND OFF� ____ __�__ �J YES LJ rvo NEAREST—♦�_
SOIL ABSORPTION SYSTEM. Ch��ch th��su�l�no�sturc at thc depth ol plow�nq FORCE ���t r.r,rf� ��ninMfrra nnnTFaini nNn nnnRKiNG
or excavation (If soil can be rolied into a wue.construction shall cease unli� '
the soil is dry enough to cnntinue.) MAIN , i
,
' _ i . --- __ _ _ --
CONVENTIONAL SYSTEM:
...- I -- � t q ir�', } , �INSIDE DIA- a PITS-. LIQUID
8ED/TRENCH � � t ,ui r1FS ' /, ,(, �tnit +.. I PIT DEPrH
�JIOIH LENCTti � O� ..DISTR PIPF.4 . .. ((�bFFi
( I
DIMENSIONS III � ] _ 3 S 1 �j I_�I Q^�'�� _ 1_
HI.'oW PIF IIAe�)�� E - � �� � � � , � �NUMBER OF �PROPERTV �Vd'!l � BUII DIN� VENTTOFFESH
�� I rI � 6 . S V �� i FEET FROM ���NE� 1 i �( AIR INLET.�[ �
t,HAVEt DEPTH Flii DEPi�� US�'.R FI�C DI �.iFt FiF[ � NO DIS7H
!��� H ��CV iNi i �E�r_�� FN(� iPE� �NEAREST—��_ I O _�S I �1 �� S 7
—�__�—St —- --- —_.
MOUND SYSTEM:
� - — _- -- - ---- _ _ _ --T -------
Mound site plowed perpendicular to Check the texture ot the fill material for �I PROVIDE A DIAGRAM OF SYSTEM
slope and furrows thrown unslope: I mound systems to make certain that it j ON REVERSE SIDE. SHOW
[ I vES C I NO �i meets the criteria for medium sand. � ELEVATIONS MEASURED.
i � - ---
SOIL COVER � �txi�`�E F�t�+�:+nNt_Ni htn!-�i-t„ i� ��SEHvn'iON WFL�S
_--—_
I I YES ; i NO I _ _u YES (�NO
- --- - -
i�CPIHOVEHTRFNCH-HED �DFPTHOVERTRENCHBE.�) DEPTHSOFTOPSOIL SODDED SEEDED MULCHED�.
' �NTER '�EDGFiS �
__ _ 1 _ _ I __ L�YES I 'NO I CI YES C]NO ❑YES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM: ____
-------- - --- --- - - --- --
TWIDTH � LENGTH�—�VC` OF LATERAL SPACWG GRAVEI_DEP N BEl i?`TJ PIPE� FiLL DEPTH ABOVE COVER�.
BED/TRENCH ( rFf'vc;FiES
DIMENSIONS � I
��iAN�f�c�'�F) PUMP Mr1Nl�(11 D DISTR PIPE MANift�l D M�TFRI�� r N�� fiISTR DISTR PIPE DISTRIBUTION PiPE MATERIAL 8 MAFKING'
��LI EV Ll CV UII� f I GV I'll'f'� I71A
E�EVATION AND
OISTRIBUTION I _ I
�II.'11 ;9�k. H(11k51'/�CWG I1ft11111�CUfiltlt.IlY t�.�)��II ".;:�I�t'.%�,' � VCHiI(�IIIFTCONRESPONDS70
INFORMATION � APPROVED Pt_ANS
' ll I ❑YES I 1 NO
n YFS [-1 NO
--
. - —
--
i P�HMANtNt M�HKtHS UBStHVAIIVN WtLL. NUMBER OF NHOPEHTY WLLL BUILDIVG�
C�JMMENTS: FEETFROM 'iNF
I �YES � �'�NO � i I YES I I N'J NEAREST—�
�� �1 v �bers �'I �-� �� I a�
�v�S`���� �D �S D rQ u.� h
RNta�n m co;mty tile for audit
tit.�rtch Systern oi� —-----
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. Sawycr Cout►ty Zoning ndminisr � a � �on
r Inspection Report '�
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M
OWnOT _ Nancy J . and James H. Albcrtin__ _ __ _ �
ta
Address Route 2 Box 2133 Havward _ __WI 54843 �
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Name of business N/A _____ ___ z
Bui1dCT Frank Cain ____ �
Address Route 5 Box 5209 H�ward__ _ WI __.__ 54843
— y
Pluwber N1A x
Address ___ _—_ . —
Inspection
(./�Private ( ) Public ( ) Froperty ( ) Sctback-lakc H
Violation ( ) DMelli.nt; ( ) Sethack-road p
O Nobi] e Ihu O S tback-lot line �
( ) Sanit&ry ( ) Zoning ( ) Garagc ( .�veraRe road setb ck o
( ) Privy ( ) for renlacement p rn
garage M
V 308 P 45 . RR-2 . 100 ' x 180 ' _ . 41 ac
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Discussed with '�� �0
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Dste 26 September 1989 _._ iv �
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Signaturc of Officcr �.r.�:� �_
David Heath , ZA �
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