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
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�43v) �vv ��� N. 1�027 �1 I�ArS�en/ R� o:
Mailing Address Mailing Address � �
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�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 >
�
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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:
/ � �
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'15
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�I B.�I b � � D�
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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. �. ,,� �+ • '"
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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.
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ROUND L/�I��E PARK SUBD.
GOV`T LOTS 45-6-7 SEC, 23 I WP 41 N. R 8 W.
-9.24.
GOV'T LOT 1 SEG 26 I WP41 N R 8 W �^
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