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010-941-21-3418-LUP-1990-186 � npplication for Land Use Ferm.it � � County of Sawyer ,a O 0 1'lie undersigned hereby makes application for a Land Use Permit and aqrees � that all wozk shail be done in accordance with the requirements of the Sawyer � County Zoning Ordinance and the laws and regulations of the State of Wisconsin. PRIN'P - USE ONLY DLACK INK/FENCIL —. ' �� �i�/!rZrl �-• Co��E-r� �<AvnrvAa�l SNI�2�FF C,�r��7- � Owner Builder ��� -�d. �� {�l ) i�- � -�;f'r`1 �.�°��L, f mailing address mailing address � I���iwF'�<`� w� �4 �" _ -o�as Nf� � ,���r �, -,� i � F43� city, state, zip city, state, zip Building Land Use Zone District r�— � ( ) New ( ) Filling s � . (7� Addition O Dredging Lot size S�� SU 2�1�� rt (�) niteration ( ) Grading u� n ( ) Moving on ( ) Acres _[p 4 v 7< ( ) ( ) New Construction Ll�l'��1�jR��M � ST�3�-�ir� '• r..��,'. (�,' Size �_ ft wide � ft wide � v1;�� � ft long G}l��Gti- �7 ft long h J' - ���dL�.ITi�►1 ui�.� �..u. 12£j Floor area � � sq ft �4-:�` sq fti i m` Total hgt ��p� to peak � to peak � � �� Stories � I � No. of bedrooms rear lot line waterliie (year round) n�wRl) i O QQ�O i " 4ype of bldg or addition i ��'��• i N � ( ) Dwelling � ` � �.� (Ya Garage (1) (�) car � i. � A'� i � (}L) Storage building j � Y rt ( ) Boatliouse � �� �" � i ol (yC� Livingroom � I 7 ( ) Bedroom j . i ( ) Kitchen-dining � � � � � ( ) Porch - enclosed/roofed i �'�.'� . � ( ) Deck - open � � �� �� j t�.) r t . j,P'�F-" '-- _ 4 y , r,i ( 1 � i.i i;,� I5 ��� r, ���-j � Gi ... Type of construction " � _.� �'� � l� , p �+ Ib � OV Frame ( 1 Block N i�` . ;� '., .%",' �5�b � i N ( ) Log ( 1 Conciete -i , C'�,�p,� 3k l 4� �r � � � � - � ( 1 Pole O Steel i .�...�,7,.,,�� i r}I� ( ) Metal ( ) � ' �. - j i � ,:'�f• � � i _m Construction cost $ _�._i� i ���,������ � �� �� --- l� ��' �'•T � ��, �/ � � :� � Vol Z.`t"4 P9 5 r�lo of deed i S�e�....�,"�_�)�`�*N �, _ � 9 i . � J !s , � �sM �o� __� p9 aG� ; , ; i `'Z ! i n � Cer. Soil Test �� i MI ISD �� � � --------- road ---------��-------- z-� Sanitary Permit �3- �S�' �L o � 1`\�RGA�.�T .�;1. z �T„n. �o r�.D Issued 31 July 1990 Denied Y � -9 , _�,_�_ 1 ' E K —1�_� i t�� Zoni_ng Administr tor . - �. , , � � , . - / / �' 6d • � . / • � , � y� ' � � • �a V �bs� � � � • ' ` • C�o i � ' , � 1�� � , � �� � I � , � .1�CA.C�E / ��°/A9 � � / ` ;; � ' / _ ._ . . ,_ ='r. C;�_�.. � �•'• �I � I � FDUND ' , . �t..� � � ,�p � � `n�� � MON. s � �5g �, ,ry � N= • S.ET B X36 ��t�, iPod i / � l� � `� �o �-- : O� (1 �� D' o . � � �l 15 BEAR/NGS BAS.FD O/>' � iz8 5�� $ .SD.CAR DBS.ERY.9T/D/Y.S I � g /9y���• � � � . . . o `� ✓U.L Y 7 /973 O s'� � �, 9D oo I ,� I �/,p �L I � 6 O/9 3p -C \� /� I �' O �2d6. /� , Y` .f 89�.38 .20� Yl� �aP� Cf- � I �� , Q � � Z��•�� � � � ���•,� ' a h a ° oo ' i � � � 4 � 9 � �� � $vo o , q i ,���CON`4I� �t � 9° zoo. 00 ' �- o S89°38 �,2Q " W Hj RONALD L. � � � PETERSON � S-eos HAYWARD � � � � WIS. � ��. � � I � ��� •�� � � i SUR�� so ' � p I I . � � SO. �y��OIIIP/` � Scc. 2% 7�5'/N, R9� I � � �i � Sou}h .(�ne ,$'ec,2/- Y/- 9� �, _ _ � - .1' 89' �8 �.�d "' YY, '�� �73"D . O � - - - � � N CD�L�,�r .G A /.a .�.10,4� ��,�I� ' _ _-�SD.DD ' . " _ ' - - - - - - - - - � 6✓ r � ��{Pd :�YVeT t7��.�..4-�. . �a,g e 1 � f Z pa,9�s• � , �_ � I , Ronald I,. 1'et:>r;;on, W.iscon<-in Rep;istered Iand Surveyor hereb,y cer•tify thr� t ] h•� ve complieel wi.t}i Ch��pter �36 : 34 of tli� Wi.scor��,in Statut�s and ur.der� ttie directioi� of Aian F'ullnr , owner , I have surveyed , clivid��d anc? m���p�d the land hc�rein described �and th�jt said land is ].ocated in the SL"i�-SlJ',�, Section 21 , `P. 41 P1, R. 9 W. descrih�d as follow: ; CommPncing at th? Southea;-t corner of �aid S �� =SW',a, Thence S. ��;° 38 ' �0" W, along the south line of said SE}4-SW�i4, 350.0 f�et to the we,terly exterision of Hamblin Street , `I'hence h'. 0° 2]_ ' �+0" W, ��long the westerly line of FIamblin Street 335 . 00 feet , Thence S. 89° j� ' 20" W, 200 feet to ttie act�zal point of beginni.rig, Thence S. 0° 21 ' 40" L, 100. 00 feet , T}ience S. 8q° 3�i ' 20" W, 20C. 00 feet to the ea�t riglit-of-t,ray of a dedicated street . Thence N. 0° 21 ' 40" W. along the east line of said right-of-wcay 200.OU fe�t , `Phence N. �+4° 58 ' 20" L. along the e��st�rly line of said right-of-way 150. 00 feet , Thence S . 51 ° 24 ' 15" E, 120. 00 fe�t , Thence S. 0° 21 '40" E, 130. 00 feet to the ��oint of be�inning. Subject to all existing eas�mentc and reservations . This instrument drafted by- Ronald L. Fetersoii July 10, 1073 . � / ����:�roved thi.:. �d�y of July , 197j by ` ��/��� Sawyer County Zoning Administrator � 44603 r.�.,:��,,r�s ott?�a � Sa�,y'c; Coun:;� � r�- i ���d I�,r tcccrrt tLe ���G -� day of ;i u 17�3 at 8'�U o'clook - , � r � _, -�t c,•.i ui c,�t c:f --- - - on r•a;,e � � Page 2 of 2 pages � c �� � �<<rr `0 _ � i��,j��.�ty � - N � � - � I N � w � � ^' - � 1 ' N � �h�Q�waFTs L4r,�� '" I - N t N y m - _ + _ _ y - q N s '" ! ti m W N "� m - A I __ H�m�B��k_ Sr��r _ _ � i _ � � = � � N � � 0 Y o;,,..: Ib 67 -:3. ' ' State of Wisconsin and County - Uniform Permit Application • for Private Domestic Sewage Systems State Permit .. /� County Permit .. Number 4� �VJ Number _s � � � � A. LOCATION OF PREMISE WHERE SYSTEM WILL BE CONSTRUCTED, ALTERED OR EXTENDED LEGAL DESCRIPTION : Name One : (Sec., Lot, Block) � •E • + of the � - w• 4 Sec . 21 T , 41 N , R 9 o CITY VILLAGE �y� RA n TOWNSHIP � B. OWNER OF PROPERTY MAILING ADDRESS � <S�O COLLETT � bCL HAYW;�D , WI��ONSIi�i Name F;yr;�;TT FULLER INDUSTRIES (Street, City, Zip Code) 5��3 C. SEPTIC TANK CAPACITY � Gallons NEW INSTALLATION x REPLACEMENT _ ADDiTION - _ MATERIALS : Prefab Concrete Poured in Place Steel —X___ Other ; No. of Tanks �pJr,_ D . TYPE OF OCCUPANCY One or Two Family Residence HUT�.SE No. of Bedrooms 2 Commercial Industrial Other No. of Persons to be Accommodated 2 (specify) E. APPLIANCES, ETC. : Food Waste Grinder YES X NO Automatic Clothes Washer X YES NO Dishwasher YES x NO Other (Specify) _ F. EFFLUENT DISPOSAL SYSTEM NEW X EXTENSION ADDITION REPLACEMENT _ Seepage Trenches : No. Lin. Feet Trench Width Depth _ Number of Lines Seepage Bed : Length 30 � Width 10 � Depth �'8�� _ Tile Size ��� No. Lines 2_ Seepage Pit : Inside diameter Liquid Depth G. Percent of slope of land % direction H . Indicate Slope of Land & direction of slope on sketch I . Tile Depth �U �� PERCOLATION TEST � Indicate Soil map number And Soil Type Hours Water Test Time Drop in Water Level Inches Minutes Test Depth Character of Soil Since Hole in Hole Interval Second to Next to Last To Fall Number Inches Thickness in Inches 1st Wetted Overnight in Minutes Last Period Last Period Period One I �ch 1 48" 8"t .s . 22" s .1 .18 ' s 16 NO �8 5 5 42 � �8" 8"t .s . 22"s .l . 18 's 16 No l0 5 5 5 � 48" 8"t .s . 22"s .l . 18 's 16 N� l0 5 6 5 � RECORD DATA FROM MINIMUM OF 3 TEST HOLES IN THE AREA IN WHICH THE SYSTEM IS TO BE INSTALLED S O I L B O R I N G S — Minimum 36" Below Proposed Absorption System Boring Total Depth Depth to Ground Water Depth to Bedrock Number Inches Observed Estimated Observed Estimated Character of Soil with Thickness in Inches 1 gi�." IVO 14t 8" topsoil 22" sanc�y loam 54" sdnd _ 2 gl.�." NO 14 ' 8" to�oil 22 " sandy loam 54" sa�i gt.�.'� NO 14 � 8" tonsoil 22" sanc�y loam 54�" " sand - -- --- -- - - - -- — -- - -- ---`— -- -- -- ----- -----� ------ -- -- -- ---- --_ _ ------ ----- -- RECORD DATA FROM MINIMUM OF 3 BORE HOLES IN THE AREA IN WHICH THE SYSTEM IS TO BE INSTALLED (COMPLEI�E OTHER SIDE) ,�._ . . �'� � �\ Name.of Owner i,1".., �.,;':1 ri��-:i:,.- : . ���:�. ,�__ ._ County �t:r;Y.ait Permit No.�S � r�� � ' PERCOLATION TESTS �' \� I, the undersigned, hereby certify that the Percolation Tests reported on this form were made by me or under my supervision in accord with the procedures and method specified in Section H 62.20 (3), Wisconsin Administrative Code, and that the data • recorded and location of test holes are correct to the best of my knowledge and belief. NAME �I.�+t�,i4�� .°;Llt,::�LF TITLE CODi'I'i��CTliit (Type or Print) REGISTRATION NO. or MASTER PLUMBER LICENSE No. 14A�? _ ADDRESS itQUTr; � �iri.T�r�I.,F ttul-,i1 �i,f;3Ew��ItD Wl�;;Uiv�lld DATE OF TEST tiu_�T• __� �� l9c'� SIGNATURE l -` � -�� � _ `- - - MASTER PLUMB R KING APPLICATI MP �� / " � �f ��� �r'� Signature�_�_ ���c. i ��l c�`� " License Number: MP RSW For: Provide sketch below of system (employer) (Include direction and percent of slope and all applicable distances) . ��el► � _ 20' .- : � ! - � .P1 VIEW Locate Perc'olation.Test& Soil�Bore Hplesj _ ; __ � ( _� �� �'f•�5'-.� �- � -�- � � � - - � , , , �__ � �,y� � - � � { ' � r � ' � � i � i i � � 1 ._ _ . � . � - ; - ; � _ 10� � � l $' � , I { _ i i � � i i I ; � _ l � � � ; _ . , ---� � _ _-, __ __ E _-�- —;- _-�- : ;- � � L I _; I � , i � 1 � � �- � ' i � , � . , � ; � � � ( i � _ , r �-� � - - � --�---� ; - } - � _i _ � �_ � � o. _ � � I __� j 5•t a 3 � � _ -- ` � = — :- , .�-. i .,- --. ..; __� T - , ___ i _..- , -.� , ;. .. i. �� � � � 1 � ; � ' � � i.._ -�-� �- �-�--� -_ ' �_ i � � ` � _ .._ _ , , - , ; �� � � . , � __ � , , , - � 5� ; i 1 ; ' ° � � � � , 1 , � � -- ` - _ , � , . 10' � � � - -� -- - - -- - , - - _ . _ _ t- � --�- + -i i . � ( ( t , � . ,_ ,_ . i . , , , � i � � , � ; � , i 5' .�_ _ . 3 a , :_ _ , _ _ ,- -- _ f _� ' __� 1--_ +- _ _ _. . l ! � 1 , , _. . ; , . � , . , _ I -- , � __r J ' 'l v ?��� � � � � __ � � -! _ __ ` , � _ , � � � � zo �� � - , — ; � - - �-- �, ( ;� � ; ,v . � - � � { -� } 25�' ' ; � I�� . . � ' ; _ , } - ! --,- -1 � - -_ � � _ , � � �. __ _ _ _- - _ ; � ; � . _ , . , I �,.L�.! � ' _ � 3,�... . i_... ; � �„ a_ � . .�,,.�.�. _ � _ I .... _. ' ` ,,, ...� ..�....., n... .e�x �,-,.., :..,�,..�...� .�,m. .�.,.... .�. C � i;� ' � • � � c ___� � i P_R�OFILE jindicate_Groundwater or bedrock wh� pplicable)_ t _ . L s ; 4- t -= , - l 1 � t i ' ' f ' i _ . __ � _ f _ � ` �__ f_ ,' f _� -o?b� � _ � ._ i :_ � ;_ 1 �._ , 9 ; : , 4 � � : � � _ � v��i }:i ' � ' -�,+'��v:L �. 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Note: The application cannot be considered for filing until all of the above questions are answered and the fee paid. ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ Do not write in space below- FOR DEPARTMENT USE ONLY Date of Application Fees Paid State County L�[�1i�_ Permit Issued/fis}eettd (date) �V�VS l �—�-� Inspection Ye�� ^ "No�Y,s _ Issuing Agent Name ��V(� �1�`.�1� _ Valid No. Date Rec'd _ DIVISION OF HEALTH,P.O. BOX 309, MADISON,WI.53701 -Revised4-1-73 �� ;�' ,' �, ��-.�.' ; . ' (�f.. ------------ . _------- __. ------ __------_, � k N i � , 1 _� �--------- l� � ``4�0� i�,'� i-- �� _ ; ,) ��% I � � �3�r _._-____--_ � � i �� __ � -___� jQ '