002-940-25-5303-LUP-1992-392 ' \ ,/
, Application for Land Use Permit �`' ��
' County of Sawyer o
The undersigned hereby makes application for a Land Use Permit and �
agrees that all work shall be done in compliance with the require- o
ments of the Sawyer County Zoning Ordinance and the laws and regu- �'
lations of the State of Wisconsin.
� PRINT — USE BLACK INK OR PENCIL 1
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Owner Builder
' `' � � �
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Mailing Address '` Mailing Address
City, State , Zip City, State, Zip
Building Land Use Zone District ('��_ � _ o �
( ) New ( ) Filling , / rt
�- `) Addition ( ) Dredging Lot size - � " u �
( ) Alteration ( ) Grading "
( ) Moving On ( ) Acres � � ' �
( ) ( )
New Construction
Size ' " ft wide ft wide
1
- ft long ft long
Floor area sq ft sq ft �
, �, .
Total htg to peak to peak � :--
.,
Stories Stories
No . of Bedrooms "��"'� � ��������� t ���
re.ar l,mt .l_ix�e.-� waterline c�
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(year round) or (seasonal) �
��, ,_..__ � ,__. . _ ._ �n rt
.__
Type of Bldg or Addition � vJ t-�
( ) Dwe 11 ing �'r'. ,-°t
( ) Garage (1) (2) car �
( ) Storage Building �� I �
( ) Boathouse Y'
0
( ) Livingroom , ' �
( ) Bedroom
�� Kitchen-Dining
( ) Porch - enclosed/roofed
( ) Deck - open `'� , f , .. �,�
� �� _ � , ? F�~
.� ! '�.
( ) � � �� �� Y ,�
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Type of Const�uction ' ��„ _ _ .��f�
( ) Frame �- 7 Block _• '
( ) Log ( ) Concrete � `\~
( ) Pole ( ) Steel '� "'7 U,
( ) Meta1 ( ) ,'`��' r c�
. � �
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Construction Cost , . - �,.
Vol 24-� Pg ��, of deed
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Cer. Soil Test �'. � � �
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Sanitary Permit p � - � �_ ----------CL Road --------------- ~
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Issued �� d���e� �g�Z Denied
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{�� Zoning Administr tor ~
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i���'�� GOV'T. LOT 3 I�
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� LEGEND O
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� O 2"X24" IRONPIPE
� t-X 30" I RON PIPE �'
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� SOIL EOf; lNG O
SCALE I'=I00' V
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I, Edwnrd E. Go'oler, n Kiscunsin Lnnd S,;rve�or, S-OOj2�, nerS,� c��rG!`.' Z
tnut ir. co-�;:liance h•ith Chripter ^�E�.34 of thP W:soonsln �tntutro, :ind in J
cr.tor::ity Nith LhP platting and zoning ordit�nce's of �aw;,-�t' Crnir:ty, 'dis„
;:nd ir�i�r thr �iireCtlon of GLENfi E, llOIJ?�I'.:;,, I206 E, liFhi?A'_,L .iJz','R, ,;��-�,= F
rsna, h'isconsin 531Z1(, the o�mrr o,` L'ne nbove pla't�d pronrrty, hnvn a.;.� ,�„_ Q
rd, mnp:�cd nna s�bdivided the nbnve ncr•ruee, t�s a certificd s�irve;•, ;ln ;;.;� W
;ot :i:. roau lities, bet�ring;; of lines, di3tnr.ces of lines as ;ot lin�y, �.�ct �
tt,c� out�i�r or:.rings :in�i distanc�¢ r;s s}:own nr� correct, in tlir f�p�;: . �
.,�,own on [tic :�oovo nlxt nnd to th� bc,t of r:; knowl�dr-�, ar� ;� co�•rrct r�?-
?_ISthnly73�n Thece�.-�rlbOc�n.?itoc��tr� thP srvne wns mn�i� by !ae on Sry.�.�.iarr
in Govr-r:,::rnt .lot ;1� s�ctl:,r, Z;, :o�r:-
s},ip 40 ::ore�,. re.nr.� 9 woat, s;,iey��r COunty. i�ieCor�,s;ri.
'��'�u•vevor Si�:n::turr
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_ SA'.`Y�R CC)U:'`L„' 0:'i T 0: CCU �lY �..��I,,',`'.3TA�; �
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::��c ��un �;r_.Srl,�� �. ta:= -2-. ; The undersigned hereby makest+ ��
� appiica�ion for a S IT f�r the premises described �" y �y
herein . The undersigned agrees that all work performed and a �, N
� equipment installed shall be in accordance �rith.� the Sanitary � �-* �
Code of Sa�vyer County and with a11 applicable laws and regul- � z ��'r
ations of the Sbate of F?isconsin : ,b ° o
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L� , ��� �tr �!'! IIPC�. Date �-/7-6� %� i� r ��"�'�tv� � z
wner or gen ' '�3-dress � �-ione h °
����<< �f�/C. � � Dat e f/`7-C� L a ✓S z
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�lumber — ress one ' I
DESCRIPTION Idld e
1, Premises 5 . Absorption Field Site �' � h
Lot size _ ft . x ft . Soi1 type � � �
Lot area sa . �t . - ; Slope I
Perc . rate
2 . Use (describe exactly as
1-fam. home, m tel, etc . � 6� Reauired Attachments
.,� - ,��- -.� .P3¢� . Wel]. permit r o y
3 . Sanitary Facilities Septic tank permit � � �
No . bathrooms >� Evidence of survey= � �
Dishwasher `�cv Perc . test form I � �
Garbage grinder -���; Div . Health revie��r
Auto , t�rasher � ,> —' �
F ��
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4 . Waste Disposal 5ystem ACTION � '
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Septic tank '��sZ' el'rmirt issued (date ) �''- (-l<'� �,
Size � 'ga� �y��� 'U��ic »�r,. '_����'�2> � c �.
N<�� - i��-�-�i-=�� --�..
SeePage Pi " / - .a. . � '- m ; ?c�,
Seepa�e trenc ` , � A_�� � / � ��
Privy Coun y Sanitar an a? ��,
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Work Started (date � i�Tork Completed(date ��G�Fee $_ � S
Permit denied (date ) for the following reasons
INSP�CTION Inspector _ �� - Date -�
, � y !n
Re rks i P /aA ' � � ,�o �� � - - �
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/�i IG •r � ' . �'�.�.e_ r.Q1
r/'!'D ���s� � �' FI�-'
RECORPIi.-,���ai��-��/��C����i.-.z�� . ��� _�� ��,�_/�� �,.
Appealed to Board of Ad,justment ( ate) Not�-_c-e ublished�l�
(date ) Copy of Notice to Division o�esource Develop- 1�
ment ( a e . Copy of Notice to DRD Regional Of�ice �"��
(date) J�ppeal Heard (date) DeCision y
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Copy o ecision o v s on o esource eve opmen a e _ ;
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Indicate Lot size and shape, Zocation of du�eZling (p), septic tank
(ST), septic field !SF) or seepage pit (�.SP) and distance of any
portion of septic system from dwe22ing, r�el2 and property Zine.
If property Zies within 50 feet of a Zake, river or a stream ao
indicate and ahow distance t'nerefrom.
If any portion of the contemplated construction wi2l tie within
2S feet of dr�elling, weZZ, septia tank, septic field or seepage
pit of abbutting owner so indicate.
The underaigned agreea that aZZ work performed and equipment
inataZZed ahall be in accordance wy'th the Sanitary Code of Sawyer
County and aZZ applicable Zaws and regulations of the State of
Wisconsin and recommendations of the Sawyer County Sanitarian.
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•4.4 JOHNSON
LA KE �•�v�
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SCAIE: I INCH=400 FEET FOR ASSESSMENT USE ONLY NG
DRAWN BY: DATE : INTENDED TO SHOW CONCWSIV'
COLON (:) INDIGATES GOVT. LOT EVIDENGE OF OWNERSHIP OR
BOUNDARY LOCATIONS