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010-841-36-5136-LUP-1992-447 • tip�Izcatian for �and Lse �ermit CoU,n�y af Sawy�� X ' � T#�e undersig:�ed hereby makes application for a Land Use Permit and a.grees ` t tYtat a�.I wark snall be done in ac^erdance w�.th t.he requirements of the Sawyer � Caunty Zoni.ng Or;�inance aazd �re �aws :a�d �egi��1_ati�ns of Lhe State of Wisconsin. �2�mt� ��r,�c,�,� �3�Z-CI,E �- }��TE�`�� �s�. ONLY 33Y,ACK INK/FENCIL � / '1,� �/ L , �� �� I�/'y`�t� .�r. %���`.� f �f��'�;1 T �[: L � o �Y Owner Builder - ��d '� �'x ra� `�.�"' � / l'?' �/ .�'�"�K c� �,, G' ____ �` ma9.Iing address ! mailinc� aadress �1 �` ���� ;�'-��'1,�,J�i c�� � " Y:r y'�,,,,?, �e5':��rf�`f �-�=' ���'y�f��f,,,� ( - � � city, siate, zig city, statn, z.ip Building Land Use Zone DiM�Y���_c�. � - � �C) �iew ( ) �'illing —A..� � � c.� ( 3 Adc�.ition ( ) Dredgina L��t. s�.�.e 131' 27f� �c 12�' �7�-r ct � { ) Alteration { ; Grad�ng �n n � ) Maving on ( ) ,'!cr�•s e!'_�8 � •��___--� �g ( ) ( ` � �.E `�� � � hew Constructioz�. STa���.- U '�S T� t�` � s�2� � ft ���;� �4 �t W�a� v ,� � �t �.o�g ��. �_� fi t lorac� . P Floc�r a��a ��p _ sq ft loT�-� �72C� sq ft � ----� vy _ � �; �'otaa h�t �/ la to peak ___._� 4o peak � � ' Storz.es .___��� Na. Uf �edrooms rear �c�+� l�.ne ar_ waterline (Ycax xaurzd) or (seasonal} � --_-----.-1 � � Type of bldg or ac�dition � � � � ( i Dwrell.i.ng � ! �, rt (x) GaragP (� � car 'Tt�vsfc�e�.f c e N¢'. �S ( ; Si.arage �auzlding � o G rt c � sQ�.tnQus� ► � n � � i o — ( } LivingrQom f E ) ;3edrr�om � � � � � ' j � ( � Kitchen-:�ining f � E ( } ;PpxC}1 — GTlC�OS2���44f�C� F ` C ? l�eck - agea� � ` � � r ;�� i G E ( } � (� '��� _ � � t � � ._ i G(� � (`-� � i C0 � l � (� - � �C � :J �'��` , , Type of construction � r�_ i w ° ► � {�() �'�ame ( ) �lac:k � ; � ( ) Lag f } C�.�ncr.�te E � `� �1 ( ; Pole t ) Ste�� � � t ) t�ietal ( � � i -� � � � i � Carzs�r�u.c�t.3 ox; �r��,tv $ �,��Qr�_ a"v P i � q" 20 8 � ► t �, VQZ -�G}� � -.__� I _ r}r c�.EL�� ` � i W 3------ � 3 !---- ' � E � 1 F CSM Vol __�..,�_. -9 ��,._r__--- � i � � t r� � Cer. Soii Test � �,.,�y r _�1-_`_-�j1_�.__.. .�.� _ E m Sanita�y �ermit �-] _���.0�_ -____.___--CI, ro�c� -.-_.__�_____________ ��� T ��0��l.�tJTa �pA-� �� x�s��a � �____.—__— l4 2 ��n�_�a �' -- ---- . �.__���_ �.__--____.�____._. ____.�. ���<x� __�__ -- ,.�� ���'� , ,��' �;� .�,�° '�.�-�.�- ���, �-� —��.)� ,� cw�ner Zar�i�,g Admini trat r Saw�fcr Coias� ty '% oniu �; �1�3;n .� riisr. c•r� �r. ion J O� Inspection P�epoz•t � Truman R . Spencer , � � Bettie A . Hogue , Trudy L . Tyson , & , � Owner Francis E . Tyson %� y -------._ _-------- -- � �C AddrEss �� 106 Shoshoni Trail _ ` Apple Valley Minnesota' S5124 p , — z Name of business N/A - ---- � Builder Harry Moeller _ __ ' � n Address Route 2 Box 1074 IIa ward _ Wisconsin 54843 ~' ---�—--- ------------ � Plumbe .r Clarence Metcalf � ---------_..__._. .__.�..__._ _ __ _ M �`�ddress Route 6 1layward Wisconsin 54843 � �_ _— ---._------ — -- r Ins�ection (� 1'?- ivate O Put> l i c ( i �'�r<��� � rt }� ( `�'9' Sctback - lake � y V �_ol .� t :ion l ) ll�,,'r1 1 i.rrt; O `ci.hacic �• road o � ) '�:c; h i ! c� I '�sl � �� ��et�� ack - lot line � ( ) Sanitar}� ( ) ��oning ( 1 G��r:� �c; ( ''� Average o . '�j ; �) i' �' l_ v;' � � __, M O �-h .��' acres Zoned R- 1 V 280 P 226 & V 341 P 208 � �_.__»_ _ _ --.--.--______�_—._____�_� x v� �3 i��� ,- , J � �1�- � _� - = -� _ _- --- - � �`. .� .�, _�-� " - - �. .t...� --���- ��� � — w .� a _,.-- _ .-� �. - `�_ .�-. ____. --- -- --- ��- — --^- -`f �—=- - — -_ �.`�".._�� � � � � � � ` i� y� 5��,+'� �. 5 I � f^ I ��rs�;���s -� -- I ?�� � I � x � � o , I i � � , _ ._ � • � . � � , u �x�5"��y�����:=_� I ^ � o '�j� i.�;- o' c-+� GA ,.�L �. o --��� � ���' .rr ` / U 541� � �n�s D�ec �,.�, ��c� �-+ � w �'✓ � f�4:. -�o �c / � 1 N � /����G l49 e S c /- h r�c (z- / 5 I o � O �f� ��z- ���.s�uG /ow � . 4,^� ' I � V. � l � � I � � � � ��"J � � � I ' plJ � I r^ . V� 1 W N � � I � '►-3 `'d °' � .� . '� � � : �I�isc.u�7sec1 i�:� it:�i cwncr ( ) ro T��_ :> cussed �.�ith builder ( ) � z:�� Discusseci ti� i'ci� plun�ber ( ) •� �•- •• Piscussed with • � ~ G'� " �. i���/l� �-- . : . � ,. � ll a t e ��// -��1 �. .___ • . o0 00 ;", Si�nature of �fficer ��,���� � David Heath - � ZA . ' . • ��:: � � _ - . ,�. � . . �� . ' :h:.� _ . . � � ' , �."ji , . #`,i'y:. . ..3�� • n: : . � i � t � � .�. . . . ,� 4.: �iN` � It►.) • a 3 D r AI o L- L. /V it J9 f y00 { f: �IJ l i 89 1 0 90' r � � � u � N O � ' N � � J/ � � N T / 0 � N �/� W ' � O C � N 0 � � rV \ .0 � � � � O W � ? 1 � � O � � � � �y �� _ N \ ' -0 � jN .. � 0 � I�l N o � � w v ? " � � ? J� J �A N :A 111 .. h4 rN oo � — 6� � D � O _ � W � Z ;p, � N N O � O � W � ?,a�ra . �.WD pp 4)j _ ' — �< �N 7� � � . p � / � � ; � T_ A O � � _ � v� � � a z \ W . v 4 N 0 • n 0 � � W � + '� � , qy .w ) � O W. � � N w � I � . T w w � � � o 0 -� O � N � � A OW �' N N i �' '�` , � O :- -""� N " O �I � W i .*:� . N _ .` r O ' � . �ip;;l�ca�i:u: "o��_ Y_�r:d. Ose i'er,nit � County of Sau;�er_ y The undersigned h�reb� nalces applicatior�� for_� a. i:and U,e Permit and agrees � ' that ali work snall be 3or.e in acccrdanc� with. the rEquirements of the Sawyer �,.�.�, County Zoning Ordinance and the 1ao�s _,nd xegnlations of tne State of Gaisconsin- O Truman R. SpenC2r, Pk<INT - IISE QNLY &LACK INK/PENCIL x Bettie A. Hogue, w � Trudy L. Tyson; & � Francis E. T son* w ___Y Harry M¢e11er r� Own.er �uilder --- �, *106 Shoshoni Trai1 Route Z Box 2074 mai.ling add�ess ^ ma�_ling address Apple Va11ey Minnesota 55124 Hayward Wisconsin 54843 __ I city, stat�, z�p --- -- city, stste, zip Buil ing Lard Ose ?oae Dis�rict R-1 (�ew ( ) Fillinq S � O Addi�ion O nreagina Lot s�.ze __221'/137'/ x 174'/123' rt � ! ) Alteratio.i ( } Gradino ^ . m ra ( ) NIoving on ( ) ,'.cres .78 t ) ( ) -- - -- — 'v�r�x m -- — --- �c o ro c��th New Construction �y�z ,ni n � Si,^.e 28 �� �aida _ _�, _ ft :vi.de �y�'� 40 _ tt long 12 �t long 5y y� C�H C�' Flaor area _1216_ sq f�t tOtd1 ____ sq ft c�9 z �r-a Tota2 lzgt _ 16� _ to peak _____ to peak Ix � � 3 Stories 1 �; --- ------ >. � ��OUN� �. Z No. of bedrooms Z :ear ?.�*-l�,ne-or o:at:er7.ine -- 2z I' (year roundj X3c��}c�A���v} - T"y�pe oP 'bldg o� ad<:;_-�ion �S�i �� � i m <� �r7 Dwelli.ng I �, � �.''T ( ) Garage (1.) (2; cas � Q� �d� � a�r,' ( ) Storage �aaildi.ng � � � r { } Baa.thous� �.5��5 � � �' ( ) Livinqrocm � —a14� 1zl! '��� i �I�w E7 � ' I Bedroom � �J-' � ( } Ki�tchen-d:.nina �� _,F �� � �� ( 3 Posch-- er�closed/rocf�d ��� G���P� i i ( ) Deck - ope.; .� �g i oa ( 1 L� 'PP /V ; � ( 1 ------- -- ��Ce" N � � — --- � � i c"' � i i �a. TyPe of constructi.on � � i i � (1�P'rame ( ) Block f � � 1 � ~ O Log i ? Concrei�� � t � r ( ; Pole ! ) S'�ecl � S�� � �P°' i � ( ) Meta1. ( i r � u, � i �N ConstrLction ca�t S 55,000.00 i i W� _ t 280 226 ; ; Vo1 341 Ya 208 of dee3 � �w N —�-�---- --- 3 51 i � �._ rn v, csK vo1389 _ r�q 71 � i w 3 9 3 31 ; �?llo� ; � '� cer. soil 'rest 87=009 ` �� ' ��, � - - — ------------��� - _ . '_}. L1���3Ca ..,._ __________ z��F Sanitary Perr.iit s7-006 _ �(�c(������ ' o �.F.., w � Issue3 18 February 1987 ne:ii.ed o� ,,y ----_ —__ ` __—_—. ... W 00 "� Greater than avera e setback conducted 11 Feb 1987 - DH , — - ------ - ��� �x�O�S-1�1 �- 1 V -�)t'.� `J~ �w Harry M ller, Contractor�� T zoning admi i—�str t� .. , � w�sconsin APPLICATION FOR SANITARY PERMIT � �� D 1 L H R SAWYER COUNTY � (PLB 67) o � oeaaaTmenTOF UNIFORM SANITARY pERMIT #p � IflOUSTRV,LRBOFI 6 MUTGifI RElF7T10115 ('C' T O '7_ O O (1 8 6 0 8 4 � l.J 1 O / 7 —Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'hx 11 inches in size. —See reverse side for instructions for completing this application. PLEASE PRINT PR��Y �NER � a �ILIN; ADD,R�SS ` / � � • o � � 7�l C 3 PROPERTY LO ATION —E+�-�'-- � CG�1/4.r/uI1/4, S 3 � , TU(, IV. R � �a�) W roy1w oF! l ��t� 2� LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROA AKE OR LAND ARK STATE PLAN I.D. NUMBER ��� �Q 0. � �6 C I TYPE�ILDING OR USE SERVED r 1 or 2 Family Number of Bedro�ms: � [� Pul,lic (Specify): THIS PEfjJVIIT IS FOR A: C►d' NewSystem ❑ Tank Replacement � Repair ❑ Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System � Reconnection ❑ Petition for Modification IF THIS I,S A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. �}Seepaye Bed ❑ Seepage Trench � Seepage Pit ❑ Holdiny Tank ❑ System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy 0 Pit Privy � Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank CapacitY �� Lift Pump Tank/Siphon Chamber Holding Tank capacitY Manufacturer. �.r IF THIS IS AN ALTERNATIVE SYSTEfJI C01IIPLETE THIS BLOCK: ❑ Mound � In-Ground Pressure Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump/Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minut per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): ( n � � Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for i all 'tion of the private age system shown on the attached plans. Na e of Plumber (Print): S' n . MP/MPRSW�Io.: Phone Number �l/'�-�O? � -�._ Q //1'1 !L '�Q .-r�f r% l� �Gf ( �� � � — PI er's ddress: �J ; Name of Designer: ,_ d � l � - u/'�Zt--� C / s�f�'�C3 __-� COU /DEPARTMENT USE ONLY Sign u of Issuing Agen • Fee: Date: ❑ Disapproved ❑ Owner Given Initial � 9 S . Q Q 2 - 1 8 - 8 '] � Approve� Adverse Determination ason for Disapp val: \ Alternate course(s) of Action Available: DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY& BUIL�INGS LABOR & HUMAN RELATIONS pRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX 7969 BUREAU OF PLUMBING MADISON,WI 53707 �GONVENTIONAL ❑ALTERNATIVE S�a�ePlanl.D.Numben (II ass�igned) ❑Holding Tank ❑ In-Ground Pressure ❑Mound NAME OF PERMIT HOLDER: E� 0.I AOORESS OF PERMIT HOLDEH�. 1�� INSPECTION DATE�. T �oN S�oS++��v� T2R � A�PP�e V u� s-ao -g� BENCH MARK(Permanem reference poinil DESCRIBE IF DIFFERENT FROM PLAN�. REF.VT.ELEV.�. CST REF.PT.ELEV. � . � �OF SI��N.� 10� Name ol Plumber: MP/IOtr{I"OP'1P� C�u���� San�ta�y Permii N�mber: ��a�c-N,c�, M� �a�F ��fq8 S�Y � 8�-oob SEPTIC TANK/HOLDING TANK: MANUFACTURER�. LIOUIDCAPACIT� iANKWLETELEV. TANKOUTLETELEV WAHNINGLABEL LOCKINGCOVER PROVIDED. PROVIDED�. �M� �I SO �lg. -( c'1$. �o� .�YES ONo ❑YES ❑rvo BEDDING: VENTDIA.: VENTMnTI i�iGHWA7EH NUMBEROF �'�� ROAD�. PGiOPERTv � WELL BUILOING: VENT70PRESH �� �� ALAHM FEET�.FROM . LINE � n� / AIR IN�ET'. ❑YES ❑NO � ❑YES ��NO NEAREST �S well yet q DOSING CHAMBER: MANUFACTURER BEDUING. LI()llll)('n!',1C:Itv VIIM�'M��17F1 �'1�h1�'SI�'��()NMnNtlln(:II�IvtVl wnf�NINC;LnNEL LOCKINGCOVER r�NUv1OLU P�70VIDED. ❑YES ❑NO C_�YES L_INO ❑YES []NO GALLONS PER CYCLE: GUMVANUCONTHOLSOPENnTIUN.IL NUMBER OF �'�{���'FHIv WELL dUILDING VENTTOFRESH (DIFFERENCE BETWEEN FEET FROM `�"E 41R INLET PUMP ON AND OFF) ❑YES L�NO NEAREST—�► SOIL ABSORPT�ON SYSTEM.Check the soil moisture at the depth of plowing �f N�,r�{ u�nn�F rE�+ n�nTF H�n� nNo n�ar+Kwr; or excavation. (If soil can be rolled into a wire,construction shall cease unUl FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: �vioTN �ENc,rF+ No ar oisrw viv[ svncw�, cnvtt� �Nsiut i>�n -vlrs �iouio BED/TRENCH I�� �S� rcvFrvc�+Es �t a+nrc+pn� l'� P�T oEPTH DIMENSIONS tQT GRAVEL DEVTVI FILL DE7TH UIS7H PU'f UiSTN PIPF. DISTR.PIPF MA7ERtAL NO n��i�+ �NUMBER OF PHOVEF7r WELL BUILDING- VENT TO FRESH BELCJW PIPES�� Ad()VE CO�'Ef7 EI F V INLI ! ElE V E.NU + NIVE ti LINELL � n� Q� AIR INLET. � �V•�o IV•�� c�� _��UC � NEAREST�—s T� weh ye� aV � 3S MOUND SYSTEM: Mound site piowed perpendicular to slope �heck 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 criteria for meciium sand. TIONS MEASURED. ❑YES ❑NO SOILCOVER rexruae ��iiin�nrvitiin�,v�hii�s uus��+vnnnHwEu-s L_�YES ❑NO CJYES ❑NO DEPTH OVER TRENCH 8E� DEPT/{()VFH TfiEN<:�1 f{Ffl �)!VI11/)F i()1'S�11L tif�l�l)f I) JFFf)F 1) MULCHED CENTER EDGES L_�YES ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTRON SYSTEM: w�DrH LENG7H No.OF Lnitrtn�SvnC�N(�� (lHnvf�. I�fP7HNF�rlwv��'! F�LLDEPT1�nHC1vECOVEN BED/TRENCH raervcNes DIMENSIONS � : MANIFOLO PUMP MANI�()ll) DISTF.PIPE MANIfpL[l MATFIiIAL Nn ()ISTH UISTfi.PIPE fll$TIiIHl11i()N PIPE MATEHIAL&M11ARKING �� � ���� ELEV. ELEV DIA ELEV. PIPES DIA�. ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HpLE SP:ICIN(, L`��ILLEU(�)fifiE(:ILV <:()VEH MA7EHIAL VER71Cl�L LIF7�pRRESPOND$TO APPRpVED a�nn�s ❑YES ❑NO ❑YES ❑NO COMMENTS: PERMANENT MARKEHS: OBSERVATION WELLS. NUMBER OF PROPERTY WELL�. BUILDING: FEET FROM ��"E ❑YES ❑NO ❑YES ❑NO _ NEAREST� _ Sketch System on Retain in county file for audit. Reverse Side. SI(i A HE TITLE � DILHR SBD 6710 (R.01/82) Q ��"�`�' ` � • . s � � g � ��ev • l�� ��t�NC�s �Y�N , e..�a� ° Govc- L-� t 3�6. � (.g GoYt' �t. 3 a-s- �I-g �� `_ �� `_�O�E L�hID ---_ R+� , ---_ ��`� --____ �3(o -6 ' -'---� C,�,�2,ok' � � �t �6 x'�S F-35i `ti . 8 ` a Gti � � , r ,� � g��,N — � �. � 56 - —�-`.------ �`-_---- -- - �--- - _ �-_ ._-_ _