002-940-35-5209-LUP-1990-261 � �
Jlpplic�ition for Land Use T'ermit
County of Sawyer ,, '
ti
<�
Tlie undersigned hereby makes application for a Land Use Permit and �yrees �
ttiat all work shall be done in accordance witl� the requirements of the Sawyer °,
County Zoning Ordinance and the laws and reyulations of the State of Wisc�nsin. �
PRINT - USE ONLY BLnCK INK/FLNCIL
Barbara Jean and
;
_Roger J __DeRoo __ _ �'�:�"� �%y �/c� � __
Uwner Builder
_�,� % "� �t j � I �%, �'�. �.'{�y�C f.,% .
mailing address mailing address
� - < '��: ; 55108 :�'� , ,� : u-'/ ` -�'- `u �
city, state,,zip city, state, zip
Building Land Use Zone District RR-2
� New ( ) Filling
r q
(� 1lddition ( ) Uredging Lot size ��+ �3
( ) 111teration ( ) Grading �n �
( ) Moving ori ( ) Acres . S 1
( ) ( ) t�
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New Co�lstruction Porch Garage �
�= o
Size J�,� f t wide 1$ f t wide
_ �
.?�� ft long 24 ft long �
co
n
Floc?farea „' ..�' .• , sq ft 4�2 sq ft �
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Total hgt �- ; to peak 12 ' to peak � x'
Stories _� � �
' No. of bedrooms ---� rear lot line or waterline
(Year row�d) or (seasonal) _s; �:., : . L �i i ;: _.. ,, -,
..,_.-t.,.. , r
i lU�.`°, _ _ ._. i c�
Type of bldg or addition � � o
( ) Dwelling � � �, C
I rY t� ,4 I rF
� Garage (� (2) car � � i a� �'
i i N.
O Storage building i �, �> • � �. rt
( ) Boatliouse � 'r - - —,-1 � N
�. J,� 4{}..� ��7 �N �•
O Livingroom � j!J_�y1 ' � , �" r i o t
i . { �� � i
( ) Bedroom � ; ;,-- � � i ,
( ) Kitchen-dini►ig i ' � , ,,; ; ? x � i�- o
(� Porch - enclosed/roofed � � �:-, i� o
( ) Deck - open � - � N
i �, � � i
( ) i i
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( ) �i � i � 1,-
Type of construction ' � Y � �
(�Q Frame �` ' ' '
� , Blo�k � ; �-� ' i i
( ) Lo ( ) Concrete � �� �
g i N� � ; ,.,-.
( ) Pole
O Metal � ; Stee i G�''k' ''4 '" �. , i
i =1p �t �oZ i
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Construction cost $1/C�r�"> , ^�.� �t: i � �
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Vol 430 F'g 10 oF aeed ; � /�' 3 ; ��
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csct vol 9 Pg 303 i i w
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Cer. Soil 1'est -'�.'`= - �`'�t,'� j i �
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Sanitary Permit _�-� - .��,�� , �j
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Issued 24 October 1990 Denied �
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Ralph J hns , builder owner � Zoning 1�dminisL-ra or
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p, o, 6. is /yS. o'NoR rH
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Register s Office l �
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Sewyer County �
Received tor record the
�-3 dayo[ SCALE / " _ /Oo FEET
AD18� � �3°o'cto�� O =RoN PiP£ /N oLnCE
M and recorded in voL � /"x2¢' IRoN p/PE PLqGED
d-.(rpn,�, oo pave 303 -3 oy �„��u����n. .
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DEPARTMENT OF '��' APPLICATION �' $qFETY & BUILOINGSm
irvousrRv, FOR SANITARY DIVISION`i'
LABOR AND PERMIT P.O. BOX 7969^�
HUMAN RELATIONS (PLB 67) MADISON,WI 53',.�J7�
Attach plans for the system on paper not less than 8%z x 11�inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal
and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in :hapter
H-63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. If designed by a Master
Plumber, the date, signature and license number must be shown. A legible reproduction of the soil test report or the owner's copy must be
included.
Property Owner: Mailing Address: �y V�� �
�/ � Jr �O /1/
Properry Location: � Cit ,Vill ownship: County: �
,S'�'/a/✓�'/oS 5'iT GN i R 6-4er 1 �N UW < <=
Lot Number: Blk No.: Subdivision Name: 7'' --`, ake or Laadmask: State Plan I.D. Number.
C/ S (If assigned)
TYPE OF BUILDING
Number of
❑ Public` ❑ Variance" ❑ Other (specify�" � eedroom::
�'"1 or2 Family 'State Approval Required. �---
TOTAL NUMBER PREFAB POUREO-IN STEEL FIBERGLASS NEW REPLACE- OTHER
GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specif )
SEPTIC TANK CAPACITY �
HOLDING�TANK CAPACITY
LIFT PUMP TANK/SIPHON CHAMBER
MANUFACTURER: �
EFFLUENT DISPOSAL SVSTEM �
PERCOLATION RATE ABSORPTION AREA
(Minures per inchl: PROPOSED (Square feeq: �'New ❑ ReplaCement ❑ Experimental �Seepage Bed ❑ Seepage Pit
/ �G ❑ Alternative (specify) ❑ Seepage Trench
Water Supply: Owner's Name as Listed on Soil Test Report Uf other than present ownerl:
�lPrivate ❑ Joint ❑ Public
I,the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Nam of P'j/�mber � MPlMoo`.-.,�..","o : p�hdone Num6ec
, /J / , � � � .7 1'� :a�a� O�.3~
Plumber's Addresr � � Name of D � ner.. 1
/ ,
� ' � 7 /
COUNTY/DEPARTMENT USE ONLY CST 83-085
Sign of Issuing A t: . Fee: Date: � qppROVED Sanitary Permit Numbec
�� . �� ],0— I8—$3 ❑ DISAPPROVED 45460
Reason for Dis roval
Alternate coursels)of Action Available:
Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to in-
stallation. Failure to comply will void the sanitary permit.
DISTRIBUTION: White-County, Canary-Bureau of Plumbing, Pink-Owner, Goldenrod-Plumber
DI LHR-SBDb398 (R.07/87)
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