HomeMy WebLinkAbout024-741-35-1309-LUP-1994-240 ^ Application for Land Use Permit �� �(
County of Sawyer l� o
The undersigned hereby makes appiication [or a Land Use Permit and a�rees that �
all wor.k shall be done in compliance wi�h the requirements of the Sawyer Cotinty o
Zoning Orciinance and the laws and regulations of the State of Wisconsin. � ,
PRINT - USE BLACK INK OR PENCIL
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Owner Builder
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Mai ing Address Mailing Address
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City , �State , Zip City, State , Zip
Building Land Use Zone District ` ' o �
( ) New ( ) Filling _ � �
( ) Addition ( ) Dredging Lot size v '�
( ) Alteration ( ) Grading
( ) Moving On ( ) Acres �(.,
� ) ���) �� T11��1, ,����, �k
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New Construction �_���
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Size �_;�' f t wide � ' wide ' wide
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` '"` f t long � ' long ' long
Floor area � `i -� _ sq ft e� sq ft sq ft �
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Total hgt � 2.r� to peak � ' hgt ' hgt x' �
,_.�.
Stories � ���t �"� � )�� �
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No . of Bedrooms .--_ rear lot line or water�����e o
(year round) or (seasonal) � ��`�� �°' G rt
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Typ e of Bldg , Addition , Use a o
(�() Dwe 11 ing �• `�
( ) Garage ( 1 ) (2) car �'
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( ) Storage Building o•
( ) Boathouse �
( ) Livingroom
( ) Bedroom
( j Kitchen-Dining `� 1:�7 ` ; `
( ) Porch (enclosed) (roofed) , �•,z- �,;
(✓) Deck - open <:��
( ) �, _ . F�r
��� — � ,
( ) ����� , � v� '`� �
Type of Construction � � '���`' �l�
1 `��, �`'� ��a
( ) Frame ( ) Block � � _ �
(V� Log ( ) Concrete �ci • J�'y r\~
( ) Pole ( ) Steel
( ) ( ) Pole/Metal ��-^� � �
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Constructzon Cost $_`: � ` �
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Vol Pg � of Deed i �
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Cer . Soil Test =� �` ;�, l�f� � ,
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�Sanitary Permit '�`� .. .' : -� -_-------- �L road -------------- o
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Issued 05 August 1994 Denied �y,;
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� Owner � Zoning Administrator
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DOCUMENT NUMBER ° AFI'IDAVIT
2 � r� � � � EXISTING SEPTIC SYST�M , �
�,
ONE AND TWO FAMILY -
11�+4�1�t'Q�Nk� ,
It the existing sepCic system does mcc� L-he n�iiiimum re- 5°`'r'r ` .""`�a' � �-'
quirements for groundwater and bedrock depths and if it �' ' ' `•''"»•-� ;.��� /.�. _ �tc�; ol
,, _ t /� ;,�,:5:�
is functioning, an addition to or replacement of a hab- - �'�`=i-- " ` y` " ----
� . � . �" ;
itable structure can be made in most instances without � ��"H � �� � - "" �"
ot _.-,-. . , ., , ,��.n'.<_____
updating the existing system. If the existing system � j '� ��, ,� ,
is utilized for the addition, every attempt should be --�" �"�"""' ' ' "'"'�` `�,_;,{:�T
made to locate and reserve an area which is suitable
�:..�....�,�,-..-__...�-....-,..�,,..e,......�_. ___.
for a code complying replacement system for when the �hr
system fails. If the addition will substantially in-
crease the wastewater discharge, the existing system RETURN TO
will be replaced with a code complying private sewage Sawyer County Zoning Admin
system. P.O. Box 668
Hayward WI 54843
owner(s) Thomas L. Buncak
Mailing address Route 4 Box 4294
Hayward Wisconsin 54843
Property description ' Part SW4 of the NE4 S 35 , T 41N, R 7W. Parcel . 3 . 2 .
Vol 455 Records Pg 428 . 10 acres . 024-741-35-1302 . Town of Round Lake .
�I) {,�� Thomas L. Buncak _ _ pla�� to
( ) Add onto existing dwelling
( ) Add onto existing mobile home
( ) Replace existing dwelling
(..r''" Replace existing mobile home with new dwelling
The present private sewage system has been working satisfactorily as far as dispo:�ing
of wastes. If the present private sewage system does fail, it will be replaced w__th
one that is cocle coi lying.
� � � �
Thomas L. Buncak d��te
d.=�te
Personally came before me this
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18th ct �� K' t� �, , 1g g4
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o n .k hak�.�, � �Notary Publi:c
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Saw er ��q�nty, Wisconsin
�sa�.ase� Cj� �
My Commission �f��p����.+� 12 April 1998
��+an
Existing septic system - Sanitary Permit 75-235
Date system installed 12-03-75
��,,�.t.c.����Lt�•� ZA or AZA �
�� — % `l _ `%�/
� date
This instrument was drafted by ,��3,� � � �� ,�
Thomas L. Buncak � ,:,;; � ;�
Plb s� � . .: r
State and County State Permit #.___���7_�_..-
� Permit Application County Permit # _�-2��_
for Private Domestic Sewage Systems County SaV�er _
�L�ENOTES STATE APPROVAL REQUIRED
csT 5-308
Date Approval Received from State if Required __.._ _ State Plan I.D. #
— -�— ___ ----_ _ __- -- ---
_ ___ _
A. OWNER OF PROPERTY ��� �}�� �f�j ��_� � � �, ��� �; Mailiny Address:
-�/,+� p ,/ ,-' L � � L L �°\ !3� ~'I /;" � �` � j�� t'" "'- i �; Ir ,;y �. �'��'O
B. LOCATION: S G./ Y4 Ni: Y4, �ection '?�, T�L N, R `�7_ E (or) W Lot# __ City _
l __ _—_
Subdivision Name, earest road,jlake or landmark Blk# _ Village _
�s:i/ Ni�,c"�/f G��' C�;, �'T��l /9 Township f�C C�t=;f' LI��.'L-�
, ' - ---_ _ _ ---._------ -
C. TYPE OF OCCUPANCY: "Commercial�__ 'Industrial_ 'Other (specify) ____ 'Variance_
Single family _� Duplex__�lVo. of Bedrooms L No. of Persons __ �-
,r —
D. TYPE OF APPLIANCES: Dishwashe�' YES _�_NO Food Waste Grinder YES �, NO # of Bathrooms�
Automatic Washer �YES NO Other (specify) __
E. SEPTIC TANK CAPACITY S�✓i% Total gallons No. of tanks _�
�Holding tank capacity ____ Total gallons No. of tanks
New Installation jC� Addition Replacement Prefab Concrete �
"Poured in Place Steel Other (specify)
F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) �' 2) �J 3) _�2� Total Absorb Area 'T-�_;° sy. ft.
New� Addition Replacement _"Fill System _
Seepage Trench: No. Lin. Feet Width Depth Tile �pth No. of Trenches __
Seepage Bed: Length 3 �: Width ;L Depth '� � Tile Depth �� No. of Lines __Z _
Seepage Pit: Inside diameter Liquid Depth Tile Size _ __`f
Percent s�ope of land =y,u Distance from critical slope_��- ��_
I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20,
Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared
by the Certified Soil Tester,�
NAME �,�-n,i..t/,-•S- �`Si"rj ii2.ti=�S�`�%✓� C.S.T. # ��-��:.�� and other information
obtained from .�.:.��-_.«_..y �i�c.-- (owner/builder).
Plumber's Signature _/�: _ - MP/MPRSW# '�'=�f� Phone #_"i�� --�'--�_�"��
���.f�
PLAN VIEW: Provide sketch below of system (include direction of slope and ali distances in accord with
H62.20, including well).
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Do Not Write in Space Below - FOR DEPARTMENT USE ONLY
Date of Application 12-02-75 Fees Paid: State 100. County _ 10.00 Date Dece_mber 2, 197�_
Permit Issued/ (date) 12-02-75 Issuing Agent Name RobyYl Ke�hart - Deput.y
Inspection YesR.�' No Valid# Date Rec'd --
!Z - 3 -�7� E�I�
1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701
2. state (pink copy) 4. plumber (canary copy)
Revised Oate 3/1/75
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FDepartment of Zonin� and Sai.itation
Sawyer County
Inspection Report
Name of praperty �� �y�
._ __. ..I2es.cription �- � J _ ��;! - y ��' !Z lc�
0•rrne r "` '
�r�6�� i�;�n - Address �`- .� - ��� «%r�' G�'�-�
Builder Address
l�a.�te.r.-�lumber �-���fy/a5'S��i� Address �,l��
` Inspection
(�) Private ( ) Public Property Sanitary Installation
Dwelling Privy
Violation X Mobile home Setback - Lake
Garage Setback - Road
( ) Sanitary ( ) Zonino Setback - Lot line
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Discussed with Builder �� Yes � � No
• Discussed with Plumber Yes No
Date of Inspection iz�� �� ��
Signature of .0�'f�cer �. ��,�
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; . Application for Land Use Permit � �
County of Sawyex ;o
The undersigned hereby makes application for a Land Use Permit and � -
a�rees that all work shall be done in compliance with the require- -o
ments of the Sawyer County Zoning Ordinance and the laws and regu- 't''�
lations of the State of Wisconsin.
PRINT - USE BLACR INK OR PENCIL �
THam�-s L . $u�vc't��
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� ��'�/Ai"/ES
Owner Builder
__�J� �ns �9� �
Mailing Address , Mailing Add ess �'
�� �/ �`� �`7"-� C�l��-rcat�t_ ►'�1 t�1 55� 1�
City, S ate , Zip City, State , Zip
Building Land Use Z,one District ��, - 2. o �
(`�) New ( ) Filling rt
( ) Addition ( ) Dredging Lot size v n
( ) Alteration ( ) Grading "
( ) Moving On ( ) Acres /0
( ) ( ) C.
New Construction
Size � ft wide ft wide .
�� ft long ft long �
Floor area ( b �� sq ft sq ft
� ��
Total htg ��{-� to peak to peak �
- Stories � Stories �
No . of Bedrooms � rear lot line or waterline o
(year round) or (seasonal) �' ~ " �" G �
Type of Bldg or Addition ' � o
( ) Dwelling �• �
( ) Garage (1) (Z) car � N•
(�) Storage Building � �,
( ) Boathouse ; �
( ) Livingroom ' �
( ) Bedroom � �
( ) Kitchen-Dining � �
( ) Porch - enclosed/roofed j �J��K �
O Deck - open � 7I9c� t r��
( )� `
�r '.�
{ � �" ` �, ���-'a____/.__ - lo�I — - _ � �
Tyne of Const�uction ,�`�' ;h - : �. j +�
Frame ( ) Block 7 I� ': ���
( ) � v. ;����c, ���
_ ( ) Log ( ) Concrete ���� � �
I / f� �S cn
(� P o 1 e ( ) S t e e 1 F�'o-�-��__ � ro
(✓� Meta1 ( ) �6� � n
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ii �d ' �°4 � �
Construction Cost $ �4(�8."" ', ! �f �,�
. /'� �-' tJ�
Vol 55 Pg ' �� of deed �' �(,4 �o-__�__�y �
w � , , ti,��� (
CS Vol < Pg _� ._ -� � , ; � "� ��y=-��� ro H
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/ Cer. Soil Test 5 -- 30�
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Sanitary Permit `7 5 -- 23�' ----------CL Road -�='Z�----------- I�
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Is sued �1 ,��u �qq 3 Denied
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s pwner �Zoning Administ ator�