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026-118-00-4100-LUP-1994-064 Application for Land Use Permi_t �� , County of Sawyer o The undersigned hereby makes application f.or a Land Use Permit and a�rees that � all work shall be done in compliance with the requirements of the Sawyer County o Zoning Orciinance and the laws and regulations �f the State oI Wisconsin. � PRINT - USE BLACK INK OR PENCIL � � /�1JN l2` �I'✓� � � �v����,v c�. ��l�T�-���r Si r-i��; .s���v��t �� Owner Builder � �j- �/ �/,�x ��-� ��� I / � Mailing Address Mailing Address �,��Y!-r�,�� c�� b��� � � ���,�r�,,� c�� r .y �%���G City , State , Zip City, State+ , Zip r o Building Land Use Zone District `�i�- � ° � ( ) New ( ) Filling � � (�G) Addition ( ) Dredging Lot s ize I� ��/U�, x 3� � � � ( ) Alteration ( ) Grading � ( ) Moving On ( ) Acres � ( ) ( ) � � i�. New Construction � Size �`� � ft wide ' wide ' wide � , �^ 16 ft long ' long ' long z� �'1 Floor area Z.2� sq ft sq ft sq ft r� � �� � Total hgt i"L- ' to peak ' hgt ' hgt x' Stories ► No . of Bedrooms �KF SisSH��Gd�� -��^r � �� ' � �--or waterline o (year round) or (seasonal) � �` � � � Type of Bldg , Addition, Use . ,, a o ( ) Dwelling � �• rt ( ) Garage ( 1 ) (2) car ' � � �U� �- ( ) Storage Building � � �,, ( ) Boathouse ^ o ( ) Livingroom —�? � � ( ) Bedroom � j�. z`� b (� ( j Kitchen-Dining - 1 ' � N i ,v � ' �) Porch (�ed) (roofed) � , .c, � A � ( ) Deck - open ly -3�o�2cu �- � �fG ' � ; � ( ) � '� �\ � -`- ` ��. \ ' a3 Type of Construction tT�� ,,�` ` � i�"� lr? t (� Frame ( ) Block r � �� " � Q ( ) Log ( ) Concrete � O ( ) Pole ( ) Steel ('� ^ F�~ ( ) ( ) Pole/Metal � � � � � � � Construction Cost $�s ' L�� � ,� � L_C- Vol `33 L� Pg /a of Deed � °G C CS Vo1 pg �.,��; H b �� �_ w Cer . Soil Test ��, C- Z ��� � � ' � Sanitary Permit �� — C�� � � �'`� ---------- L road -------------- � � �, - z �, 7i���, o �� � � .�vr� �ti%� S,,rS'y o�c �v� � Issued 03 May 1994 Denied y, � � s�� � �� ��VHQA6r SethacK ��6,� O! 5e�/t'rn�-- l�'I�� ' `�N" ZCennv�G, �f4�o�5rJ,1.� .�� � � � � , ��— (�ner Zoning Adminis�rator � i Sawyer County Zoning Administration , �j �� Inspection Report � �_. ►�' Owner Kenneth Jacobson Address 16670 Franklin Trail SE Prior Lake MN 55372 `�' � . n Name of business N/A � � 0 Builder owner z Address � z z Plumber Lincoln Quinn � � x Address P .O . Box 133 Stone Lake WI 54876 Inspection (� Private ( ) Public ( ) Property �( ) Setback-lake Violation (� Dwelling-+�' ( ) Setback-road o ( ) Mobile I�m ( ) Setback-lot line � � ( ) Sanitary ( ) Zoning ( ) Garage Q(j Average waterline ( ) �'rivy ( �� setback ;� °, 0 � Vol 352 Records Pg 271 , w � �/�-J �i 1 rl �!'19/�`ii /y' - � a - - ----- --- _ __--- r _ _ _ �__ � �--- _ �/ � , � ,- �S �� � (�� �` % � �'l' � t i � � � �--- - - . �, x � � � �," �` � � � o �.---1 < < �����d,�y � , t , ����� i ;� r ���z.� .. o � �� � { � r+ �' � ; � � � I j � � , � � w � + �• � � �� `-' I � I � � � ; i � i � �. � � z � � , � � � �Ii� �41�S 1 �vc✓�r�Pr�• � --( � � � � � f � i I �r� � �� c � � , ; � c� '��► ; � � � � � � �,� 0 � , I �, � , ; � � . � � � � � a Average waterline setback of 65 ' �or future construction of deck ,� w piscussed with O�Nner ( ) � � biscussed with builder ( ) �, Discussed with plumber ( ) z Discussed with Kurt Lof�ren/Frontier Realty � � Date Ol September 1983 . '� Signature of Off.icer �-i�c�,��_�� ���,t,� � David lleatli � � � �I �/ �1 �/ W �/ ��V � �,� � � � �-; _ _ ��. . _ _ - - . - - - - _.._ ._ - � .�-��, � �_.i-- ,�. , ,�.l� , __. . _ , ; . , - -�° ' ` _� � i � �`, / .7,� i�------ �G,�'_� �_.��"_� � � �� I � �� _. . . �� �- � 1 � � � z , � ; � � � � i � �._,, , ,�, � i �, i �� �- ,,�' . � r,� ,��----�._- -- � � ,ii ,o�- • . �- �� _� ,� � �-`� �i �' ,P � j �; ,_� _-�, , -� � A ��' � - r� t � � I � \, � �� � .S� (� r� ''1 l� Cy� �`�' (.+: � � ' � w '��, � � � \ � w 1,�� -�j -(�� � � � (� �� J� � � � ,� \� �„ ,� ' � � I ` '', ��� �1 /t' p 'CU P �r, Q, i (7� �E- �' �� n> Oo _ � .� � .� � ,n � i , A _ � �I o � i:� � � ,,�:.. ;��: f � .s� i� (J� �� � r;f �� . C - ,_ �� \�, �. �'�l � 1� / �1. I��' `� `'_ 1,J. '.� 1�' / � � •Oo 1 ;��,� ��P � � �-V , I �" Lv � 1 �J � �=� � ; �� ' i 2 o G �' i � 3 %; �J i i' /O 1� / O/� ' __ � I � � y io � � % � � �i _-- /o i ' � ' � / / � � 1 oii � , � - - / c �' I . I . � � W - ' / ni O_ I —�L' I \, . ��-�_..� 1 i' � <,! ? _ --�--�---__ _ �/` �--- �. � � . _ _---- 5eC � - - b � . � __ � - ---- __ -.- --- - - - - ------------ -- ------ - - _ _ _ ��_� �I' % ; -- - ----- � .. ` .�' , / , , . Application �or La.nd Use Permit a Covnty of 3aveyer � � The undersigned hereby makes application for a Lend Use Permit and *° agrees that �ll r�ork sh�ll be done in accorda.nce with the require- menta of the Sa,�yer County Zoning Ordinance and the laws and reg- �;^, , ulations of the State o�' irisconsin. �' PI�A3$ PRIIP.� - II3E BLaCK INR OR Pffi'�CIL p Ann W, and � �i�- /j`l 1{,'E C'1d�E57�oK;'`� � ���'l�6AI �l� ! ` .Tn�Tr��= er er y 8t 7 --- � 3t�� ;:�t.'�' ac�utfl �S?g2 ,2�' a resa ma a ess '��/ �Ge��%-% �J a'�f/d..1�,/ . t:;'�'�!/ "7 li!_)/�J7`�0�: , Lc.�� %%y��=�' Building Land Uee Zone District RR-2 � New Filling � Addition Dredging Lot aize 101/102 x 363/388 Alteration Mining �� Moving on tirading Acres . 86 � ' � Nex Construction ) or (�easonal) -constructed `� �`,�.�,._�i ' _ ,�� � i����, ��-r� �. ,< , . ., �_ Size ��� �t wide � /� ft wide� J �' , � -�------- -: � ' ft lo �:,� � ;'. � � �� ft long �;�.�r n8 _ � � �. ;� Floor area ;%��' sq ft �� .� sq ft i';;'� , ,,� ,� - .� Tota1. height /�; to peak ____l�,to-��eed� � � �� `�' ��H"''`'� � Stories ' .�._..��i s/.����%.�. � No. of bedrooffis �>; rr�,terline ____.____ � e o� structure � D�elling � Garege (1) 2} car Storage buil ing �'� -7O � ` Boathouse Livingroom Bedroom — � � �^ Utility room ; � b � Kitchen-dining �, ' , � �. �, Porch - enclosed � � F � �� µ � Deck - open ; N � � ��� � � � � ; Z4 �' o �; e oP construction �- Z ok � Frame Block (� Log Concrete � - Pole Steel � � Metal � r Eetimated coat $ ��� 2�i � �� L CST 83-202 x L C Vol 3 34 Pg 10 4 of deed �+ CS Voi - - - - - -1�� - - - - - - - I� ' �, Sanitary Permit : 84-019 ' � -------CL road ------------ � � �owry �1�-D � x 0 Issued 25 Anril 1984 Denied ' t � Avera e setback ins Ol �eptember 1983 : DH: Kenneth Jacobson . � , --------_ � � � ` ,� . � — � on � � � wisconsin APPLICATION FOR SANITARY PERMIT � � DILHR SAWYER � co�ry • � (PLB 67) � � oecaaTmEnroF UNIFORM SANITARY P�RMIT� I--� - If10U5TRV,LRBOq 6 MUTRfiRELfiT10f15 ��� g�_ �O� 5 2 2 6 0 - `D —Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/�x 11 incfies in size. —See reverse side for instructions for completing this applicatio.n. PLEASE PRINT PROPERTY OWNER MAILING ADDRESS l �-r l '�- � r� S � ' � ^ -�1 / P OPERTY LOCATION CiTY: � LAGE: 1/4;��-1/4, S O, N, R E (or W� OWN OF: " �/ � ��, LOT NUMBER BLOCK NUMBER SUBDIVIS ON NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. �JUMBER // T � ,`�' ��C L� s�' 4 � � TYPE OF BUILDING OR USE SERVED � 1 or 2 Family Number of Bedrooms: � [� Pu�lic (Specify): THIS PERMIT IS FOR A: � New System ❑ Tank Replacement ❑ Repair � Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System � Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. � Seepaye Bed ❑ Seepage Trench � Seepa�e Pit ❑ Holdiny Tank � System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit �s On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total ,}`rof Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity tj � Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: � G IF T�iIS IS AN ALTERNATIVE SYSTEf�1 COIVIPLETE THIS BLOCK: ❑ Mound � In-Ground Pressure Total r�`rof Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump/Siphon Chamber Manufacturer. PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA �n/ATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): � /,�Q � ,�O � Q Private ❑ Joint ❑ Public I,the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print�: Signat MP/MPRSW No.: Phone Number: r D/ }s CJ .l'�o � 07�� Plumber's Address: Name of Designer: �r-- � � t' � - 't�"�--'`�- COUNTY/DEPARTMENT USE ONLY Sign re of issuing Agen • Fee: Date: - ❑ Disapproved �p 7� . �� 4- 2 5- 8 4 '�Approved � Owner Given Initial Adverse Determination Reason for Disappr val: Alternate course(s)of Action Available: DILHR-SB�-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber JEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY tx l_ABOR & HUMAN RELATIONS pRIVATE SEWAGE SYSTEMS ` P.O. BOX 7969 BUREAU OF PLUn MADISON,WI 53707 C�CONVENTIONAL ❑ALTERNATIVE s,a�eP�a�L�.Numbec . (11 as:igned� ❑ Holding Tank ❑ In-Ground Pressure ❑Mo�nd NAME OF PERMIT HOIDER�. ADDFESS OF PERMIT HOLDER�. WSPECTION OATE�. i � r��U �.��vTi- �/7 �3 �d�• S. /n .a /�in.iv- s i - - 8 y ' BENCH MARK(Perma�e��reference poin�l DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.EIEV.: CST REF.PT.ELEV Name o�Plumher: MP/MPRSW No.�. Coun�y�. Sanitary Permi�Number: 0 8' Ww ��-- 8'�1-0 �9 SEPTIC TANK/HOLDING TANK: MANUFACTURER�. LIQU�D CAPACITY�. TANK INLET ELEV.: TANK OUTLET ELEV.: W.�.RNING LABEL LOCKING COVER G PR VIOED: PROVIDED�. / — l�C �J D �� ! �5 YES ❑NO ❑YES �NO BE DING� VENT DIA. VENT MATL.. H1C3H WATER NUMBER�F ROAD�. PROPERTY WEII: BUILDING�. �VENT TO FRESH �� ALAHM LINE-. � � .41R INL_T FEET FROM Z S 7 S ❑YES ❑NO � '.� CJYES ❑NO NEAREST � 7 � DOSING CHAMBER: r� AIANUFnCTURER BEDDING�. LIOUID CnPl1CITv PUnAP MC)DEL PU•.1P'SIPMON MANUFACTIIRER WAqNING LABEL LOCKING COVEF C PROVIDED-. PFOVIDED: /-`Y//9Cq ❑YES ❑NO � �D '— �YES ❑NO ,q�YES CNO GALLONS PER CYCLE: PunnP nNo coNrao�s oPEanriorva� NUMBER OF PROPERTV WELL BUILDING VENT Tp fRESH (DIFFERENCE BETWEEN FEET FROM ��"E AiR i"�_T PUMP ON AND OFF) ❑YES ❑NO NEAREST SOIL AB:iORPTION SYSTEM.Check the soil moisture at the depth of plowing �EN�rH oinMerea n+nreain�nrvo mnaKwc .r exca� ,tion. Uf soil can be ro�led into a wire,construction shall cease untii FORCE he soil is dry enough to continue.) MAIN ONVENTIONAL�YSTEM: WIDTH� LENGTH� NO.OF DISTR.PIPE SPACING COVER INSIUE DIA. SPITS Ll�l,iD BED/TRENCH /� � �/ ' TaerueHes / � s,ar ain�: PIT oeP-» ' DIMENSIONS �o �o � GRAVEL DEPTH FILL DEPTH UISTH PIPF DISTH.PIP€ DISTR.PIPE MATEfiIAL� VO DISTR NUMBER OF PROPEfiTV WE�L BUILDING: VEN7'0 FRESH BELOW PI i 1S ABOVE COVER ELEV.WLE T ELEv.END PIPES FEET FROM �LINE. AIR I1._"cT �O �� QU.S_ U• �� U3�I NEAREST—� '— 75� 7Z`� ^ MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- meets the cr.iteria for medium sand. TIONS MEASURED. ❑YES ❑NO SOIL COVER TEXTURE PERMANENT MARKEHS OBSERVATION WELLS ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH BED DEPTH OVER TRENCH,-BED DEPTH OFTOPSOIL SODDED SEEDED MULCHED. CENTER EDGES i ❑YES ❑NO ❑YES ❑NO ❑YES CNO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH TRENOCHES LATEFiAL SPACING GRAVEL DEPTH BELOW PIPF FILL DEPTH ABOVE COVER DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIGE MAMFOLD MATERIAL�. NO.DISTR. DISTR_PIPE DISTRIBUTION PIPE MATERIAL&MARKi'.G ELEV. ELEV. DIA. ELEV.�. PIPES DIA.: ELEVATION AND DISTRIBUTION INFORMATION HOIE$IZ_ HOLE SPACING DfiILLED C()RHECTLV COVER MATERIAL VERTICAL IIFT CORRESPONDS TO APPFf"ED PLANS ❑YES ❑NO ❑YES ❑NO COMMENTS: PERMANENTMARKERS: OBSERVATIONWELLS: NUMBEROF PROPERTV WELL�. BUILDING� FEET FROM ��NE ❑YES ❑NO .. ❑YES ❑NO NEAREST Skecch System on Retain in county file for audit. Reverse Side. $ E TIT�E DILHR SBD 6710 (R.01/82) � ��--� �, � �o`�'� : � ����r .�,.���,�,�)� � � . , _ �'�L;.��~µ� c�,'��C � . � ('� '��Se� • �I \ ,C O e� � o �� ' � a -� t a �e- _ � P� � G� 0 7 5"� �5� •1.y,^ • � S �� 30'� 5`c� . 7�,� �` �. � e� � � ,-. << G(Le�wsc� y� P'�.G i y� �,, � ,� 5 ,� Z G\� 4` �� ,�' rZ �p � �� ���' 303 y �C' Q' � ,�-c�e 55 ►�