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HomeMy WebLinkAbout010-171-00-2904-LUP-2004-003 � Application for Land Use Permit r y --- County of Sawyer ° � O . PO Box 676 -Haywazd WI 54843 � 715/634-8288 y � T'he undersigned hereby makes application for a Land Use Permit and agrees that all work � � shall be done in compliance with the requirements of the Sawyer County Zoning Ordinance and the laws and regulations of the State of Wisconsin. � , NO CONSTRUCTION MAY BEGIN UNTIL ALL PERMITS HAVE BEEN ISSUED. t'' � PRINT-USE BLACK INK OR PENCIL S O W 1�UAri+1 �r- ,lIM��1 �YR��-AA1 �'AG}� �a�S�Y-ovr`� � r Owner Builder °' O <' �43v) �vv ��� N. 1�027 �1 I�ArS�en/ R� o: Mailing Address Mailing Address � � \ � � �j v�q rv�' �'Yl YV 5�D 8 t �-,-R�-1 w R r-v W 1 S 5�`d`1 3 c� � City,State,Zip Ci�ate,Zip y � l�51 -`f o� - 5 q 5� �11�� l.�3'�! ' '-I�-t"L"`� � Daytime Phone Daytime Phone % � 9 �lpl� y � Additional Information: Zone District � � � Lot Size .�i��;�?,t_ - i �T ; Acres .`1�� '�' Is the property in a Shoreland District?(within 1000'of a lake or pond,within 3 0'of a river, � � creek or stream) If yes,how far from the shoreline&water name: R oOr�� L R�'i� D Is there wetland near the proposed structure?If yes,how faz o � Building Land Use b ( )�Tew ( )Filling Floodplain:( )Yes �No # ti Q(j Addition ( )Dredging � � ( )Alteration ; )Grading Chippe�va Flowage: ( )Yes (�T�Io ��; ° ( )Moving On ( ) � o ( ) ( ) Driveway:( )State ( )County ( )Town Rd. � -� -J Primary Structure Accessory Building Ad rtion � ( )Dwelling ( )Gazage-attached/detached (�(�Deck ( )Yeaz round ( )#of caz stalls ( )Porch ( )Seasonal ( )Storage Building ( )Enclosed ( )Frame built on site ( )Screenhouse ( )Living room � ( )Modular/manufactured ( )Greenhouse ( ) tchen ( )Mobile/manufactured ( )Other � _ Q(�Bedroom � I ( )Other primary structure ( ) � ( )Relocate/enlazge ( ) ( ) ( )#ofnew > � co Addirional Informarion: ��g��� X �y' ����� + b a�h ��a-�r t��� " �� " ro N -}-.-: i�x!:{��;� 1�w2�i�rua� � � rn �FT of Construction a rame ( )Log ( )Pole/metal ( )Block ( )Concrete � ( )Other �, � Construction Cost:Primary Structure$ Accessory Building:$ Addition:$ �5,ocx� ao z 7y Vol 58`i P 2-g `I`t� of Deed Certified Soil Test# 9l-022 � CSM Vol�_Pg 1�_Lot# Sanitary Permit# 9�-a54 Plat Envelope ��L Or: � Condo Vol Pg Year Instailed Aff of ex septic Vol Pg Owner When Installed: Gazd Gazebo Vol Pg W i LL��R rrh -4 R K*�t ����"A� � �C� �� Ins ection Date: 1�I/6��� Previous Variance: LUP: P Describe the construction using these columns.List the dimensions of each structure in a separate column.�ist each story,each addition,each alteration in a separate column. #1. Rab�+1��r� #2. #3. #4. Size IA R,� ft.wide ft.wide ft.wide ft.wide 2'�` _ft.long ft.long ft.long ft.long � Floor area y`I6 sq.ft. sq.ft. sq.ft. sq.ft. Hgt fiom grade�_to pealc ft.hgt. ft.hgt. ft.hgt. Stories�_ stori stories stories #of bedrooms�=N�tiv 2 �x �d� �- b� +�+4 � Rb�n�� �.wK�e ���,1� � Lot Line or Lake/River name: / � � � � . / . '15 . , y Pe� zo �.� � � *'°��� N `�� �,�;� �� 1 �-- 3`�' - V�3S\ , � �w�� k��K 24�,`l� 1H' , �� �ti o �� iY En� � 24 5 GQ,,Aye � �I B.�I b � � D� I ,� b4� � Fire Number and Name of Road 0 l 6Le t�l S Lv�ft 1 oa' � I.Fill in lot dimensions and indicate north by arrow. r� ' Signature of Owner or Authorized Agent: 2.Indicate location and size of existing and new structures. 3.Indicate location of well,septic tank,drainfield. — t'`��--(-'J``'-''*'� 4.Indicate distance to existing structures,lot lines,septic system. ���-(�� 5.Indicate distance to the ordinary high-water mazk of any]ake, , pond,river,stream,creek,and name the body of water. P�^�Nerr�:�`'``"K S�os{rv� The above certlfies that the listed informaGon and intentions are 6.Indicate any grading or clearing in excess of the construction site. wa ana conect.rne aeo�e Perso�Sis nerety 9��e ve��ss�o�ro� access to Ne property for onsite inspection. 7.Indicate distance to any wetiand. Permit Fee: Tanuar� 1'� 2004 � Issue Date Signature ofIssu g g t January 13, 2005 Expiration Date Office Comments: Inspection Date: 50%Rule Applies: Avg.Setback: Restricrions and other informarion: r 3 SAWYER COUNTY ZONING ADMINISTRATION Statement of POWTS Capabilities . (Private Onsite Waste Treatment System) I (we) William and Amy Jeatran k � understand the POWTS serving the structure located at ' -' � 10786 N S�lvan Ave , Hayward , WI was designed far the following capabilities: : Treatment Tank(s) Approx. 8 0 0 (',pD C on c r e t e t ank Soil Absorption Cell(s) Peak 3 0 0 GPD Average GPD 220 mg/L BOD 150 mg/L TSS 30 mg/L FOG Permit Number 9 7 - 0 5 4 Year installed 19 9 7 The POWTS serving this structure is presently sized to accommodate a total of 4 people, in a dwelling Return To: Sawyer County Zoning PO Box 676 containing 2 bedrooms. ( exi s t ing ) Hayward WI 54843 ` Adding a 3rd Bedroom to the dwelling . WI Dept. of Comm 83.54 outlines the management Tax Parcel Number: O 10 - 171 - 0 0 - 2 9 0 4 requirements for these POWTS and I agree to comply with those maintenance provisions as they apply to this system. Should my use of the structure described above increase flows above the capacity of the POWTS, I agree to upgrade my system to meet the standards required in WI Dept. of Comm 83. Should my POWTS fail, as defined in Section 145.01 (16) Wisconsin Statutes, I will obtain the required permit for the installation of a code-compliant POWTS with the installation completed as ordered. LEGAL DESCRIPTION — See attached page n sicrrATu��s� � ,�� � ��r, _ � *Typeorprintnamehere: Wil 1`am D . Jeatran Amy L . Jeatr K� ��" DATED THIS � DAY OF c� ct vt G , a. c� o �/ ACKNOWLEDGMENT ,,�l";`�=`-�`;;,'}��. STATE OF: �� -S C�Vl S I h COiJNTY OF: Sc� w y '�� 4°`;,;��'�a�F.:�� '�,�,j.�,'`p,, Subscribed and sworn to before me by the above named `�"4+'��° � p � " � '``'- `i, e p j�� � `f � on this d `" "� day of �� v� u c� v� �r � 20� �� ��"� W �`�� . � � — - � � �;' � = NOTARY PUBLIC � � ' `� � � . � a � *Type orprint name here: ��it f�tq �Q`� �� r. �. ,,� �+ • '" .- q o � � � ��� . . ^ r •ff�� y ���� Y �i�1 \ MY COMMISSION EXPIRES: �fn�-i I 3�, r100 (v 'r'��.�i� �qr4�%`Q>�}vo�`��` �� �J�:�iBS{f�i3'��`�i` *Names of persons signing in any capacity must be typed or printed below their signature. TKIS INSTRUMENT WAS DRAFTED BY: Sawyer County Zoning Office; PO Box 676, Hayward WI54843, 715/634-8288 t " �j ( Tax Parcel No. 010-171-00 2800& 010-171-00 2901 i That part of Lots Twenty-eight(28) and Twenty-nine(29), Round Lake Park Subdivision,more particularly described as Lot�ve(5)as recorded in Volume Eighteen(18)of Certified Survey Maps, pages 147-148,Survey No.5452. �o��u�aaw� a.��� ����������ur��• .��uui�or�uu .a.- �' ' • _'__.__'_ '.""_'.__'_'_..._-""_'__'_____"_"_._..'_'_____' __"-'_____"___'_"'.___"___1 � . e�-e• n•o• r-:� e•-c• �:_;., . . ...-,. �c,-y .__- _. .'__.__ .—._'_ _._. ., .. . . �__._..._._t _ I �'__' "_'-_--"__'_ . ' � � i��axr'srae � `.:'.:�; .. . ------ .. .. ... � � � � ..� ir.�� � F��.-\ —._'__'_ _—"_'__ -____ _-_' __'_ ' N �a.,�.,s -1� � � I I I '� ��.���- -. 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