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002-184-06-0200-LUP-1990-189 .K _ 71pp1iciL-ion for I�and Use Fermit ' Cou►ity of Sawyer F� . o S' 1'he undersigned hereby makes application ior z Land Use Permit and agrees � � that all work shall be done in accordance witli tlie requirements of the Sawyer ° County Zoning Ordinance and the laws aud regulations of the St�te of Wisc�nsin. PRIN'i' - USE ONLY DL11CK 1NY./PLNCIL � ,1 Ct.U� d �. /1 r�.��r�k �f,'c�r� e_ _ l 'l c°-1 C"C�L� 6t°s2�z � Choner Builder ��C�, ; ,�� /`� /� _._L��-- ,80�- /3 7�' . mailing address mailing address �✓Y f�/�,C`�� G v/1 .5 ���� . �(Ot!P_ �C�' K � lili�S J����� city, state, zip city, state, zip IIuilding Land Use Zone District �j�<' t ( ) New ( ) Fillinq (� l�ddition O Dredging Lot size S � ( ) Alteration ( ) Grading n � n ( ) Moving o►i ( ) Acres , ��L� ( ) ( ) `� � New Construction ' � Size �_ f� wide ft wide � �� f t long f t l�ny • Floor area _`�-�`— sq f t sq f t tn � � � 'I'otal hgt � �r, to pe�k to peak %" � � Stories �_ � � No. of beclrooms -� rear lot line or waterline (year rou��d) or (seasonal) _ � i �•---------i ci Type of bldy or addition � � � ( ) Dwelling � � � � �� � i G rt ( ) Garage (1) (2) car � • � « �' i i N. O Storage building i i C rt i N• ( ) IIoatl�ouse � � N (,'�tl Livingroom j -� ��,Z,,d - ''? � � ( ) Beclroom i n ��x? y�N , �� s'�`� (X) Kitchen-dining i r, �" _ .,. � �S ( ) Forch - enclosed/roofed r'�,, �•� ��� �hZ i � ( ) Deck - open � ' � i �' ( ) i i��,"� � � ( ) ' � � � � � i , � e.. Type of construction i i (X) Frame ( ) Block � � � i ( ) Log ( ) Concrete i � i,� ( ) Pole ( ) Steel � , � i i a- ( ) Metal ( ) i ✓ � jv � i i y' i� c- v' i i �o Construction cost $�S, ��C, � . �� i C`, � —� � � i� Vol � pg�y oP deed � i � i � p esrt--��_�g_� �j ��V, -��� i i "' ro t i � � i Cer. Soil '1'est ��,�; -��`=�', � � � �-� �' ----------CL road ------------------- z � Sanitary Permit �� - ��Z p T (� 1 ' r � f / . l �-1 t-,L�V�T h� �l�3" �j1i`�'�.� � 4 ` � � � Issued 31 1 990 Denied n ��� ` �J � �, s�-'�.-�'� � `" '� � '' "�"�" � � ��--- - ' �, owner 7oninq I�dminis rat r �' '��` . � � � ; �' DIL�R SA,NlTARY RERMIT' AP�LlCA�101� COUNTY � in accord with ILHR 83.05, Wis. Adm. Ccde SAWYER '� � '�"'""�""`^"^^�^�� STATE SANITARY PERMIT # ` ; C CST 88 - 038 104228 ` ' —Attach complete plans (to the county copy only) for the system, on paper not less tha.n STATE PLAN I.D. NUMf3EA � 8Yz x 11 inches in size. r —See reverse side for instructions for completing this application. PETiTioN 1. APPLICANT INFORMATION — PLEASE PRINT ALL INFORMATION. FOR vARinNCE ❑ � Es ❑ No PR ERTY OWNER , PROPERTY LOCATION ` '/4 '/4, S � T , N, R g E (oi W PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME �� � /��rc. {7?JOi✓ I CITY, STATE ZIP CODE PHONE NUMBER CITY NEAREST ROAD, LAKE OR LANDMARK r-- VILLAGE : /J �- i , G /� b � e✓U� ✓ ��t', II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family Z- OR ❑ Public (Specify): ill. PURPOSE OF APPLICATION: (Check only one in #1. Check # 2, 3 or 4, if applicable) 1 . a. �New b. ❑ Replacement c. ❑ Replacement of d. ❑ Reconnection of e. ❑ Repair of an 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�i. IV. TYPE OF SYSTEM: (Check only one in #1 and only one in #2) 1 . a. �onventional b. ❑ Alternative c. ❑ Experimental 2. a. ❑ System- b. ❑ Holdiny c. ❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1 . a. ee a e Bed b. ❑ See a e Trench c. ❑ See a e Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED ;Square Feet): PROPOSED (Square Feet): / !� /, � � Feet �rivate ❑ Joint �� Public CAPAGTY VI. TANK Site in allons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New xisting Gallons Tanks Concrete glass App. Tanks Tank:> structed Se ticTankorHoldin Tank �.Sd �=ti-cee, ❑ ❑ ❑ ❑ ❑ Lift Pum Tank/Si hon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans. Plum er's Name (Print : Plumber's Signature: (No Stam MP/M�- Business Phone Number: � / c �,,�/� � �' � �z ��� �v- -�� Plu ber's Address (Street, City, Stat , Zip Code): Name of Designer: ,� �j' .�d x � ?��i c_ � � VIII. SOIL TEST INFORMATION Certified Soil Tester (CST) Name CST � l t�C �/�� �Cr-�'i�.� �.�j/�) CST's ADDRESS (Street, City, State, Zip Code) Phone Number: � � � � (',c� 7� � 6 - 3 IX. COUNTY/DEPARTMENT US O LY � Disapproved Sanitary Permit Fee Groundwater ate iss g Agent Signature (No Stamps) I � Approved ❑ Owner Given Initial Surcharge Fee Adverse Determination � . X. COMMENTS/REASONS FOR DISAPPROVAL: J I � — — 1 SBD-6398 Iformerly Plb-671 (R 03/86i DISTRIBUTION: Original to Cour,ty, One Copy To: E3ureau of Plumbing, Owner, Plumber i � i, i � �'I -� �' � ; � � �i � �i ------___ � � � Y--- -� .� � � � � - � j �� � � � � � � � � �� � � , I � � �' �v � i � � �'� � O ` , � � �L'` �:; — — � !� �s� v I � � �� � �,� � I ��� O � ;- �j `� ..� � � \ �� q .i � µ �� � \ � / / �— O .` _S � �� _�1 '� � � � � � �G-�j� ./� b ��� �� l SEC. 5 &6 TWP 3 9 N. R. 8 W. ��,P� y� � ��' - �p.� 4�$ . yE�r �• /� �4 1 �� �b `y� �� �2 ��6, a�j. �5 �� ��-�G ° c>�' .� \V� �6� .��� a ��� � .��� '�y. 6� G�J�� % •6g `. '�y / 6,� -� ` `h� P�� � a � .� �6 v / . / / �'t�Z �'I �� G �6 .�6. ��� �``y. � � � � � 6 ��' \� 1�p `,�� � `6. ��� / �6� �g• 6 �6 .�6 `,�9 ���� � 1 � Z ��a? �` OCr >y `g. � � �. � ��b �• .�� �.' 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