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HomeMy WebLinkAbout028-742-27-5301-SAN-2022-284 � SAWYER COUNTY ZONING & CONSERVATION ADMINISTRATION � 10610 Main Street, Suite 49 � Hayward,Wisconsin 54843 9J (715) 634-8288 � sanitarian(a;saw�crcounriQov.or� q� � COUNTY SANITARY PERMIT APPLICATION In accord with Chapter DSPS 383,Wis.Adm. Code and Sawyer County Private Sewage System Ordinance APPLICATION INFORMATION—TYPE OR PRINT PropeRy OwnePs Name Property Legal Description ��,�L 'v1 ��l��N(�S L.L�- GL "3 '/4 '/4, Sec. Z�' ,Twp. `�Z N,Range '� W Property Ow r's Mailing Address Lot Number Block Number z.ZZc w. med i I� �vz� `+ City,State� Zip Code Phone Kumber Subdivision Name or CSM Number C-��C-� ` � '�t-- (cp��7 ( 7�S� S�'� -3 7 3Z TYPE OF BUILDING: (Check one) ❑ State Owned ❑��ry Nearest Road 8�;.�5�`� R�. � Public ❑ 1 or 2 Family Dwelling—No. of bedrooms � ❑village [�Town of S�I�C�� ��e Fire Number (b Qi��� PUBLIC BUILDING/LAND USE: [Explain the use/purpose for this Parcel Tax Number: (12 digit legacy number) permit,(i.e.,campground,festival,recreation/entertainment even[etc.)] Cfi.n� G Z � _ `I L4- Z- Z�- S 3 c t TYPE OF PERMIT: Additional Information: ❑ POWTS Reconnection(SAN#_-� �POWTS Connection (SAN#_-_) �(���L *Attach a Plot Plan with all required information per SPS 383.21 ❑ POWTS Revision(SAN#_-_) �i 4�1�� ❑ POWTS Repair(SAN#_-_) *Soil Test Information(CST#�-����� ) ❑ Other: v� �G9fi� *Gallons per day (SC RESPONSIBILITY STATEMENT: I,the undersigned,assume responsibility for the installation of the POWTS activity for which this permit is issued. Plumber's Name:(Print) Plumber's Si �� MP/M�P�tfrW ho: Business Phone I�umber: �0.5661 t�1Ae-Tle-1 (07S7J 1 �71� 7!�- 5 3S� Plumber's Address(Street,City State,Zip Code): , �P o , - �� C�� C'��(v l c��r s`���a OFFICE USE ONLY: !��/ ❑Disapproved Review Date: ermit Fee: Date Issued: Issuing Agent Signa[ure �Ap roved ❑Owner Given Reason for �d> ��� � �� ' ��11 �,Z Denial � � �I�� a 'Z �,e=,;�U.cX�-� ��f/j— COMMENTS: **Expires 2 years from date of issue** Expiration date: �� I!I J a o�� CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: �` S��,.� r r�� _ -- ,.� F"'i �!� �q 10 � ►� I � � _ '� � ����`��'�'�; ,� - , -___ __.._._,.._,._,� , rY����� ' '70 _ i' �:� , _ � ���,�.� � 3 � . -- '_ �i�� �� ���� � � �.5�a-a — �(� �-{ Ne,�/ wqr 1 � �3� �a._ � .__ _. �� Rev.04/21/15 ._ ��"�'- . , '.;iV � ��� � NO R�FJNDS AFTER �SSUE OF P�M�- 1' f1 , =40' V`j QV1E,Q-�tbl ��l�l tvl(tS ��LC '-�J CQ�e c U J Z220 W, IY1eC���f� Y�V� � C:CV1�ec'f P�/7hlf 'O � >� �io C��cCt�o� T� �c,(�ti7 Only -�r t �R � ��5� SS� — 373 z S-tG{�{�ou5e � �wr�h So�l �e��i�) j o�'7b 6� U�c�s C2rn� (�CL ���. S�� 1 c�I y�O „ I (,OT �} 5�- � T r-f Z N i F: 7 U� (,��'�9r I\I E 7'owv� o-� S��G�e� La�e Saw�e r Cc�,� �os �� �ke � 028-�4z- z8- �"�cl � ,,� QYYI = Ib0�L $c��vY� o� L�C� s�G��I15 L N.U;.Ce�e�' o� s1�eP�r,y C�b�in C�� ����u� bl = ���q'7' � s�s�� =4s.��'�Exis+��y� � �Y�s�c nJC �i4Srri i:SSe� �bb0 5�T�(C L�`E�� C.�� �z�,r5 ��h�Shn� KCtSnIuSSz/I SIE'CQ�� �Q�U)� D�sr. 3t;c 1660 ���E-cN � Se��t[ �;��<S �2 �Mis�+^J Lct 3c�'n Sa` ��n;E �i.;e�� � a"<< ° tX —BI ShciC�✓� _��Fm. $_�F ' (31��' Prc o Sec� W IeSey^ 3� �r� L �y �r��h t P�S�w4C�2, ��unP p��pos��P � (3K Sfn� ��� CcF�tn B�`!S C-'o-�uti�P �'D . ��,, .. , � �Qsat� F�Ueffz� ,- ' � / 1MI��(a 75'15! ��� p f J ���\ �I�-D�ZZ 1 r�JC�rc �LC � \_ ��,