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Home My WebLink About022-738-12-3301-LUP-2004-354 Application far Land Use Permit(*Non-shoreland*) r � , � County of Sawyer � � �� PO Box 676 -Hayward WI 54843 O 715/634-8288 � *Property that is not located within 300'of a creek,river or stream or within 1000'of a T flowage,lake or pond or does not have any of the above watexbodies located within >> the property's boundaries. � , CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED. � �;�� a�a PRINT-USE BLACK INK OR PENCIL (,' a' (Y�„;k �1Q Q-F� C`3" l 1 �-�es-�. a � Owner Builder � �C7 F7i�x • �� T �� Mailing Address Mailing Ad ress O � �\'��;c.n ,_vJ'i_ S�I 8 b 7 �.i?(?��c�„�� City,State,Zip City,State,Zip � 1�5 - ��s - ay�y ��71s- a►��, ti�o1 _�- Daytime Phone Daytime Phone Additional Informarion: Zone District: �' -� Lot Dimensions: Date lot was created: Acres:_�� % �' o Is there wetland near the proposed structure?If yes,how far � - Building Land Use Floodplain:��-j Yes� (�No �� -� � ( )New (�)Filling rn (�)Addition O Dredging Driveway access off of a(Check one): � O Alteration O Grading (X�Piivate Rd O Town Rd. o ( )Moving On ( ) ( )County Hwy ( )State Hwy N � � ) � ) o `�+ t� Primary Structure Accessory Building Addition � ° ( )Dwelling ( )Garage-attached/detached �� (�Deck w (�)Year round O#of car stalls O Poxch = O Seasonal O Storage Building O Enclosed � (�Frame built on site O Screenhouse (�Living room � ( )Modular/manufactured ( )Greenhouse ( )Kitchen � ( )Mobile/manufactured ( )Other (�c)Bedroom �, � O Other primary structure O (�.)Relocate/enlarge Q� � � � ( � ( )#ofnew �� C� � , L, AdditionalInformation: � � � � � - o .J Type of Construction: — (1Q Frame ( )Log ( )Pole/metal ( )B1ock ( )Concrete � q� ( )Other ,..d .� Construction Cost:Primary Structure$ �� Dj) �(� � � � Accessory Building:$ Addition:$ z� �^! � cio Deed:Vol �`�-- Pg /C'� Certified Soil Test# : z CSM:Vol Pg Lot# Sanitary Permit# `l� -'�Irf�/%`.) o, � Plat Envelope Or� N � Condo Vol Pg Year Installed: � � � Aff of ex septic Vol Pg Owner When Installed: Previous office approvals/actions: \ Variance:# LUP:# SP:# CUP:# Inspection Report:# Change of Zone District: �I�7l�l a�3o8 ', � , Describe the construction using these columns. List the dimensions of each structure in a separafe _ column. List each story, each addition, each alteration in a separate column. #1 . #2. #3. #4. " Size�� ft. wide ft. wide ft. wide ft. wide � ;_ [� ft. long ft. long ft. long ft. long Floor area ,5?�� sq. ft. sq. ft. sq. ft. sq. ft. Hgt. from grade to peak ft. hgt. ft. hgt. i�. hgt. Stories �_ stories stories s�o�ies # of bedrooms _�_ � , � � ,r " � � ine , 3� ;, v - I I� ( 3 ,`` �W aJ � � G c�L�� , � t-��,,� �y �ru ' -_F � �� . , }-�o� G�za�c ��_ I , . � ' ��k 4 � ' � '�� ' _ � , �= - ��, e , ��.. , �. - . ► �,-� ,� 0 o�d � . ; �,�,� ' _ �vo 'rl� }-j��se S I�s 4 ��; ____ ______ � , m , o��e �� 3� . pc�es �. �r � Sod . - - - - - - �� Nw a� �a - - � _ __ - -- -- - - _ _ --- --. Fire Number and Name of Road /)() � ' Vv S fa�F�e �d o� '�1�'7t� 1 . Enter lot dimensions and indicate north by arrow. Signat re f Owner or uthorized Agent: 2. Indicate the location and size of the requested construction ��, ` Signature activities. ��_��,��' �,�j Print Name: 3. Also, indicate the location and distance to the well, The above certifies that the listed information and intentions are true and correct., that all work shall be performed in compliance septic tank and drainfield, wetland areas, lot lines and to the with the requirements of the Sawyer County Zoning Ordinance and the laws and regulations of the State of Wisconsin, and if centerline of the road. a�t��9 as ow�er�s� a9e�t, has the permission of the owner(s) to perform the work requested on this application. The above personsls hereby give permission for access to the property for , onsite inspection. � � O_ Permit fee: $ �—� . • �, �,}� t-r;,s c � ,�act � e; ll��r� `�ed'r'�`uy� � �As Y�:x�l.e :.� �nS� `v�-u•' � , �n 1 1� �nu' r h.�' a' i cl i2C'��l'y� e�',tit �,v�tl. �-hi5 Yli.w �d�fi,w. ;1��i 1?��R-e�c� }.i-, ��e rr.e.�,�` t,�i�P k� �� a �y ` . e. r July 13 , 2004 - Issue Date Signature of Iss in gent July 13 , 2005 50% Rule: Average Road Setback: Expiration Date Office Comments: WISCONSIN 'S NORTHWEST DISTRICT , ZONING ADMIN[STRATOR'S ASSOCIATION COIJNTIES OF: ASHLAND DOIIGLAS PRICE TAYLOR BAYFIELD IRON U WASHBURN BIIRNETT LINCOLN SAWYER SEPTIC SYS�`EM INSPECT[ON FORM Reques[ed by: LL r' p 2Gf1` County: , v ^ Address: Town City, Village: ��' �r� _ Cicy, Scate, ZiP� Phone• �� I`� ' �1�5 " o� �� Legal Description: �� ',� '/. of S t�� '/, of section i �_ T �_ N, R � E / W Owner/Occupant: �(Y�A� �;�,�-� Sepcic Address, #, Name: Address: ��,(7 . `1� X. `� a Sepcic Serves: Ciry, Sta[e, Zip:��,�y)�,-� � �� `j`j4�'�"� (ex. # o � home barn, school, church, induscry, etc.) Tax Parcel # Date of conswc[ion: H y:y� If conscrucced after ]anuary 1 , 1979 enter DILHR sani[ary permit number (if available). SEPTIC TANK INFORMATION Information obtained from: owner pumper � other Tank Cons[ruccion ILHR 83. 1 S( 1 ): concrete steel�� fiberglass other Approximate tank size (if known) � -��' / Has che [ank been pumped on a regular basis per counry maintenance agreement? Yes� No Per owner Per pumper Pumper's name ' � Has the tank been pumped prior to the inspection? Yes No Per owner Per pumper � Was inspec[or on site during cank pumping? Yes L�'" No Was sludge/scum level grea[er than 1 /3 of total volume prior to pumping? Yes No '� Evaluate condition of baFFles: General condi[ion of septic tank: lnlet Oudet i.e.: cracks/holes in cover, sidewal(s, bottom Good `� �/'� explain: Need replacemenc Missing MANHOLES Is service cover more than 6" underground? Yes_r1 No__ Is service cover above grade? Yes No '�� Does cover have a warning label, chain and locking device if above grade? Yes �No Is service porc in code compliance? Yes�No Is there a manhole riser on cank? Yes No i/� Is service cover riser properly sized and watertight? Yes �No Is there a 4" or larger inspection opening at baffle opposite service cover? Yes t% No Is inspection opening or pipe a[ leasc 6" above grade? Yes _ �� No / SEPTIC SYSTEM Canventional Bed Trench Pit (cirde one) In Ground Pressure Mound A[Grade Privy Approximate Age: O[her(explain) Towl Area: sq.f[. Is sepcic tank and dosing tank in secback compliance from: Dis[ance in feec: building? Yes No Unknown well? Yes No Unknown high water mark? Yes No Unknown loc line? Yes No Unknown pool? Yes No Unknown o[her? Yes No Unknown Is chere a dosing chamber? Yes No Pump—floats—alarm siphon checked for proper operation? Yes No Is absorption field in se[back compliance from: Dis[ance in fee[: lot line? Yes No Unknown high water mark? Yes No Unknown pool? Yes No Unknown well?(excep[for schools) Yes No Unknown other? Yes No Unknown Is there an approved vent presen[? Yes No Is the vent funccional? Yes No Is there wa[er presenc in the ven[? Yes No #of inches Was a soil boring conducted 3'below existing ryscem? Yes No Unknown Depth to groundwater? inches Depth to mo[ded soil? inches Is there exiscing soil site evalua[ion available? Yes No �Was boring done by a CST(Certified Soil Tester)? Yes_ No_ Unknown Is owner aware of any backups,surface seepage or discharge,odors,slow drainage,etc.? Yes No if yes explain I certify that che above information is true and correct to the best of my knowledge as observed on , 19 Operacional aspects and observations reported are based on the conditions noted a[[he time of inspection. This inspection does not in any way guarancee or warrancee che con[inued opera[ion of the syscem described herein. InsDector's Signamre Geden[ial Number Dace Attachments required: ❑Approved plans ❑Soil test reporc ❑Copy of maintenance records(if available) ❑8"x 10"plot plan of house,well,tank(s)and soil absorption system .o. .6. KIN6 �6.4 � .6.5 .5. I .6.6 .6.7 .6.8 .7. I .8.I .10.1 •9�1 .14.1 15.1 .��.� .�2.� 112 .12. � .12. SCALE: I INCH= 40Q FEE DRAWN BY: � COLON (�) INDICATES GO