HomeMy WebLinkAbout014-941-12-4104-LUP-2004-464 Application for Land Use Permit(*Non-shoreland*) o o '
County of Sawyer �
PO Box 676 -Hayward WI 54843 -�
715/634-8288 �
*Properiy that is not located within 300'of a creek,river or sYream or within 1000'of a
flowage,lake or pond or does not have any of the above waterbodies located within
the property's boundazies. _ ]R
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED. i�f�,
PRINT—USE BLACK INK OR PENCIL �
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Owner Builder <'
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Mailing Address Mailing Address � �
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City,State,Zip ��-�,=E rir��/ City,State,Zip
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Daytime Phone Daytime Phone o
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Additional Information: Zone District: 2�'�
Lot Dimensions:
Date lot was created:�� Sf6'i %�� Acres: 2 81 n
0
Is there wetland near the proposed structure?If yes,how faz .�%� G �
Building Land Use Floodptain:( j Yes OO No � '�
( )New ( )Filling �
Qq.�lddition O Dredging Driveway access off of a(Check one): •`D
ao
O Alteration O Grading O Private Rd ('j'T�own Rd. o s'
( )Moving On ( ) ( )County Hwy ( )State Hwy �.w, �
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Primary Structure Accessory Building Addition � °
(�Dwelling ( )Garage-attached/detached ( )Deck W
( )Year round ( )#of car stalls ( )Porch �
( )Seasonal ( )Storage Building ( ),Enclosed �
O Frame built on site O Screenhouse �Living room � �
( )Modulaz/manufactured ( )Greenhouse ( )Kitchen
( )Mobile/manufactured ( )Other ( )Bedroom � �,
( )OYher primary structure ( ) ( )Relocate/enlarge �
� � ( ) ( )#of new � �
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AdditionalInformation: � p
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Ty e of Construction: Q �
�Frame ( )Log ( )Pole/metal ( )Block ( )Concrete J�
( )Other
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Construction Cost:Primary Structure$ � �
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Accessory Building:$ Addition:$ So 00 ��� � �
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Deed:Vol 708 Pg Z5'' Certified Soil Test# 96'�9 °° z
CSM:Vol�Pg ,Z°/ Lot# � Sanitary Permit# 9!0-ooZ o, ^�
Plat Envelope #5� Or: �;, �
Condo Vol Pg Year Installed: �
Aff of ex septic Vol Pg Owner When Installed:
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Previous office approvals/actions: O0 _3PZ W
Variance:# LUP:# 46-Cn5 SP:# CUP:# �
Inspection Report:# Change of Zone District:
91z"�a1�n
1'19(r�
Describe the construction using these columns. List the dimensions of each structure in a separate
column. List each story, each addition, each alteration in a separate column
#1. �OU � �'i i �° ��� #2.Sc�r�� P�k'c/f #3. 0l��rJ U�C�K #4.
Size � �. ` ft. wide /�/ ' ft. wide I L ft. wide ft. wide
�`/ , ft. long �2 , ft. long �ft• long fr. long
Floor area 3 C� � sq. ft. �sq. ft. /�7 sq. ft. sq. ft.
Hgt.from grade to peak ft. hgt. ft. hgt. ft. hgt.
Stories stories stories stories
# of bedrooms
Rear Lot Line
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Fire Number and Name of Road ������' ,✓ � R �� �� '��
1. Enter lot dimensions and indicate north by arrow. Si nat re of pwner o thorized Agent:
2. Indicate the location and size of the requested construction � Lc.�' �(� � ` Q.
Signature
activities.
Print Name:
3. Also, indlcate 1.Ile lOcatlon and dlstance t0 th0 well, The above ceNfies that the listed intormation and intentions are
We and crorrect., that all work shall be performed in compliance
septic tank and drainfield, wetland areas, lot lines and to the w�m me ����me�c� or me sawye� co��ry zo���9 om��ance
and the laws and regulations of the State of Wiscronsin, and if
C0IIt2rIlIl0 Of T118 TOad. acting as owner(s)agent, has the permission of the owner(s)to
perfortn the work requested on this application. The above
personsls hereby give permission for aaess to the property for
onsiteinspection.
Permit fee: $ 7 S
P�
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Sentember 1 , 2004 � 1 iu �[� �(1�.���c �-�.f.D�v ��
Issue Date Signature ofIssu�ig AQ��t
September 1, 2005 50% Rule: Average Road Setback: _
Expiration Date
Office Comments:
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, vviiconsinoepartmentof�ndustry, PRIVATESEWAGESYSTEM County:
�aborand Human kelations INSPECTlON REP�RT sGtw { `r
Safety and Buildings Division
(ATTACHTOPERMIT) sa�rta�yPe�mittvo.:
GENERAL INFORMATION �Cp - OOa
Permit Holder's Name: ❑ City ❑ Vl�lage Town of: State Plan ID No.:
�ce�p 4r1�. S—Io�'1 L<r.fo0 ParcelTaxNo.:
CST BM Elev.: Insp.BM Elev_� BM Description: .
�O — �n4� � r.66o.. ti" Po l Ol4-G41 -� a •4to�F
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic �� � �� Benchmark (p
Dosing
Aeration Bldg.Sewer
Holding St/Ht Inlet �j � ."� 1p
TANK SETBACK INFORMATION St/Ht Outlet � �.S
TANKTO P/L WELL BLDG. ventto ROAD Dt Inlet
Airintake
Septic � {ZS � �ZS NA Dt Bottom
Dosing NA Header/Man. �j � .3<
Aeration NA Disi. Pipe , �-]
Holding Bot.System ��3�
PUMP/SIPHON INFORMATION Final Grade q 3 ,9 t'
Manufacturer and
Model Number GPM
TDH Lift Fri ' SYstem TDN Ft
liea
For in Length Dia. �rst Towell
SOIL ABSORPTION SYSTEM (�
BED/TREN�H �Nidth � Length No-Of Trenches PIT No.Of Pits Inside Dia. liquid Depth
DIMEN I N 14 �"k1 — DIMEN I N
SETBAGK SYSTEMTO P/L BLDG WELL LAKE/STREAM
LEACHING Manufacturer.
lNFORMATION 7ype0 CHAMBER Mo elnlum er:
System: �`3¢,� 'f 3� �"Z$ 'FS�` n .u- . OR UNIT
DISTRIBUTION SYSTEM
HeaderlManifold DiStributionPipe(s) xHoleSize xHoleSpating VentTOAirintake
Length _ Dia. Length _ Dla. Spacing _
$OIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over zz Depth Of zx Seeded 1 Sodded xx Mulched
Bed/Trench Center Bed/Trench Edqes Topsoil ❑ Yes ❑ No ❑ Ves ❑ No
COMMENTS: (Indudecodediscrepancies, personspresent,etcJ
Plan revision required? ❑ Yes ,�] No � �w ��ti Z 3 a
Use other side for additional information. � ��o �0 � � �
SBD-6710(R 05191) � Date Inspector'SSignature Cert.No.
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SAWYER COUNTY CERTIFIED SURVEY MAP N
� PART OF THE NEI /4-SEI /4 . THE NWI /4-SEI /4. SEC. 12 a
T. 41 N. . R . 9 W. � v
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p O W
NORTH IINE SEI/4 � � � �— '
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2azo.ze� R.a ,'O, x r�
^ SB9'42'S0'E 2621 .80' : : Z�,
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OCQ 66.00y ^ .
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FD. 2' f .P. �' Q 389'42'S0'E 259.73" N 89'42'S0'W v�a
ACCEPTED CTR I/4 COR. SEC. 12 •' � 768.00' N N�
� HY SURVEYOR GOBLER .'�p� �
� V p
Q w 3 b
a°�� oe LOT 1 a ; ��
Po QQ'O ��A- I 22. 365 SF . n � w o
Q.�. '. 2. 81 AC. ,� Z
\".' 6� _ '" - �+
J
QP Y
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O2' � 5 B9'42'S0'£ 505.55' vPi �'
0P2Q . a.
\OO N \
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�2 � L O T Z g FD. 2- CAPPED I . P .
'� ' � o Y SE COR . SEC. 12
a . yo 00 (41 .693 Sf , �
tiQ' �� �� 3 . 25 AC. �
3�y 2 r
S 89'42'S0"E 688.06'
.'� ... .... ..................................
� 432.06' N89'42'S0'W 256.00'
10' UTILITY EASEAIENT SCALE I � - 200 �
o� LOT 3 �r
,�o� 124. 244 SF . N � � SET 3/4' X 24" REROD.
2 . 85 AC. o H WT . I . 50 LBS/FT.
0
N
N e9•a2 so-w 5i4.se' R .A. RECORDED AS
BEARINGS REFERENCED TO THE
EAST LINE SEI /4 SEC. 12
(ASSUMED S00' 29 'S9'W)
SURVEYORS CERTIFICATE
I . LYLE L . ELLIOTT. REGISTERED LAND SURVEYOR HEREBY CERTIFY THAT BY THE DfRECTION OF
TOM FO55 . I HAVE SURVEYED AND NAPPED THE LAND PARCEL wHICH IS REPRESENTED 9Y THIS
CERTIFIED SURVEY MA? .
THE EXTERIOR BOUNDARIES OF THE LAND PARCEL SURVEYED AND MAPPED 1S DESCRIBED AS FOLLOWS .
A PART OF THE NEI /4-SEI /4. AND THE NWI /4-SEI /4. SEC. 12 . T. 41 N. . R . 9 W. . TOWN OF
LENROOT. SAWYER COUNTY. WISCONSIN. AND MORE PARTICULARLY DESCRIBED AS FOLLOWS :
COMMENCING AT THE EAST OUARTER CORNER SAID SEC. 12 . THENCE 500' 29 ' S9'W 66.00 FEET:
THENCE N89' 42 " 50'W 768 .00 FEET 70 THE POINT OF BEGINNING: THENCE S00' 29 " 59'W 557 . 21
FEET: THEtiCE N89' 42 ' S0"W 256.00 FEET: THENCE S00' 29 ' S9'W 237.42 FEET : THENCE
N89' 42 ' S0"W 614 . 56 FEET: THENCE N37• 58 ' Il 'E 1004.08 FEET: THENCE S89' 42 ' S0'E
259 . 73 FEET TO THE POINT OF BEGINNING.
SAID PARCEL CONTAINS 6 .91 ACRES MORE OR LESS . AND SUBJECT TO ANY EASEMENTS OR
RESTRICTIONS OF RECORD .
I HAVE FULLY COMPLIED WITH THE PROVISIONS OF SECTION 236. 34 OF THE WISCONSfN REVISED
STATUTES AND TH£ SUBDiVISION ORDINANCE OF SAWYER COUNTY IN SURVEYING AND MAPPING SAME.
I 'riEREBY CERTIFY THAT THIS SURVEY 1S CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF .
' � \_ � `\`���u�in�ui��ry /
,��' SCON ��•,
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: =.
LYLE ' ELL 10TT. RLS f 300 � � ''•. �
DATE : SEPTEMBER 25 . 1995 ` �� i„YLE L ELL!OTT•��'°
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