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Home My WebLink About030-737-08-3401-LUP-2004-516`1� Application for Land Use Permit(*.Non-shoreland*) o; o ' County of Sawyer � � PO Box 676 -Hayward WI 54843 � 715/634-8288 *Property that is not located within 300'of a creek,river or stream or within 1000'of a � flowage,lake or pond or does not have any of the above waterbodies located within � � the property's boundaries. ,, CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED. r; 1 PRINT-USE BLACK INK OR PENCIL � I /S' � � r:r',r��a I�I I = �-�r��1 l ��f�Y1ce � Owner Builder �: ��l�S�� l �-�,,1�( ��1-ia ° � � � Mailing Address Mailing Address � �`�V1E '�Ct1C�� `1 �4��Il� � City,State,Zip City,State,Zip � � `c�i r�- �-'tl-�- l-�C'�� }._ Daytime Phone Daytime Phone X Additional Information: Zone District: -}�tU �-- r -�- Lot Dimensions: "' Date lot was created: Acres: �L S o �^ .� Is there wetland near the proposed structure?If yes,how far � � �s Building Land[Jse Floodpfain:� j�i'Es (iv�No �� — (kfNew ( )Filling � t� rn S O Addition O Dredging Driveway access off of a(Check one): � ( )Alteration ( )Grading ( )Private Rd (�own Rd. o � (�/)Moving On ( ) ( )County Hwy ( )State Hwy ti, � l�)�U�('r'� V�1b�,i�(' ( ) o � ��nornP r Primary Structure Accessory Building Addition � ° (�Dwelling ( )Gaiage-attached/detached ( )Deck W - Q�Year round ( )#of caz stalls ( )Porch � �� ( )Seasonal ( )Storage Building ( )Enclosed � {.�' O Frame built on site O Screenhouse O Living room �� ( )Modulaz/manufactured ( )Greenhouse ( )Kitchen �; � ,j .Q�Mobile/manufactured ( )Other ( )Bedroom t,�i \ �' ( )Other primary structure ( ) ( )RelocaYe/enlarge � �%�'� � � ( ) ( )#of new -� �, � ��, �� RI AdditionalInformation: �� p � r �� , F,-� 0 Type of Construction: � I"�1� ( )Frame ( )Log ( )Pole/metal ( )Block ( )Concrete � � �-� r:� �.ott�er�1��1 >iv�c�l� v�;i�P2 �'�'il��Y�i�P Ltc�rnP ,� -� /� � Construction Cost:Primary Structure$_��l� � � --� � �o- �t � Accessory Building:$ � Addition:$ � z� (,U � 3ti3yz1. � -� S � Deed:Vol Pg Certified Soil Test# O�/-,3� °O �z CSM:Vol Pg Lot# Sanitary Permit# b, � �� _� Plat Envelope Or: C`�1� , ��r � '�j � j �, � � �. Condo Vol Pg Year Installed: F ��u� c r � � � Aff of ex septic Vol Pg Owner When Installed: � v' ky Previous office approvals/actions: _ � Variance:# LUP:# I,�C-C��s SP:# CUP:# \,� � �Inspection Report:# Change of Zone District �\ c� 3it��o � 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. #2. #3. #4. Size ft. wide ft. wide ft. wide ft. wide ��% ft. long ft. long ft. long ft. long t ` Floor area ►a �' � sq. ft. sq. ft. sq. ft. sq. ft. ` Hgt.from grade to peak ft. hgt. ft. hgt. ft. hgt. � { Stories � stories stories stories � #of bedrooms r-z, Rear Lot Line � IY � ��'�� .� � � � . � __=----r . _ _,___ ��. ._.�..�--___- Lot- ��`�2� �- �� "l � S �ff� � � � ld' � �_ �� e�(�S�`�-��, a, b��, � � � �; ,_, �� `�� .� , -- � a� ;� .,� �—� , f� `�=- ;,, ti=�`�,__ � A`SN) L � �7�,��U ,� '. � �n . `�n V �, `��' � � \ \ � / v� _ Fire Number and Name o �oa� (��=� �`�� '� � : � , �_�x' ��'�'��a 1. Enter lot dimensions and indicate north by arrow. ${�nature f Owne o �Authorized Agent: 2. Indicate the location and size of the requested construction ��'1,�� Signature activities. C�`�/S�I.A-� C.��,l(`�f 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 ali 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. aot��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. Permit fee: $ r� � � . '" ��' September 16, 2004 Issue Date Signature of um ent September 16, 2005 50%Rule: Average Road Setback: Expiration Date Office Comments: WISCONSIN'S NORTHWEST DISTRICT ZONING ADMINISTRATOR'S ASSOCIATION COUNTIES OF: , ASHLAND DOUGLAS PRICE TAYLOR ' BAYFIELD IRON RUSK WASHBURN BURNETT LINCOLN SAWYER SEPTIC SYSTEM INSPECTION FORM Reques[ed by: �(U��-{�� "lC��'1('{ Counry: ��UQ'(� Address: � �S�� }-1p��lrf� � (�i iP Town,Ciry,Village: Ciry,State,Zip: Cy P�(1�t(�� l.v� Phone: Legal Descripcion: � '/,of s U�! '/.of seccion g T �, N,R�E� Owner/Occupant: Sep[ic Address,/l,Name: Address: Septic Serves: Ciry,S[ace,Zip: (ex./f of homes,bam,school,church,indus[ry,ecc.) Tax Parcel N Date of conswction: if constructed afcer January I, 1979 en[er DILHR sanicary permit number (if available). ��SEPTIC TANK INFORMATION n(orma[ion ob[ained from: owner pumper�� other Tank Conswction ILHR 83.1 S(1): concrete s[eel_� fiberglass other Approxima[e tank size(if known) 7 S�Z�,��; Has che[ank been pumped on a regular basis per county maincenance agreemen[? Yes_� No_ Per owner_ Per pumper_ Pumper's name�iu� ,S Has che�ank been pumped prior ro che inspeccion? Yes_ No_�Per owner Per pumper Was inspector on site during tank pumping? Yes_ No� Was sludge/scum level greater[han I/3 oF total volume prior to pumping? Yes_ No�� Evaluate condi[ion of bafFles: General condition of sep[ic[ank: Inlet Outlet i.e.: crackt/holes in cover,sidewalis,bo[tom Good ./ ,% explain: Need replacement Missing MANHOLES Is service cover more than 6"underground? Yes t�No Is service cover above grade? Yes__ No� Does cover have e warning label,chain and locking device if above grade? Yes No �/ Is service por[in code compliance? Yes� No_ Is there a manhole riser on tank? Yes No ;/ Is service cover riser properly sized and watertigh[? Yes� No Is there a 4"or larger inspection opening at bafFle opposire service cover? Yes No '-� Is inspec[ion opening or pipe at leazt 6"above grade? Yes No � SEPT C SYSTEM Conve� Bed Trench Pic (cirde one) In Ground Pressure Mound Ac Grade p��y Approximate Age: Other (explain) To[al Area: sq. f[. Is septic tank and dosing [ank in se[back compliance from: Dis[ance in feec: building? Yes No Unknown well? Yes No Unknown high wacer maric? Yes No Unknown lot line? Yes No Unknown pool? Yes No Unknown other? Yes No Unknown Is there a dosing chamber? Yes No Pump - floats - alarm siphon checked for proper operation? Yes No is absorp[ion field in setback compliance from: Disrance in feet: loc line? Yes No Unknown high wacer mark? Yes No Unknown pool? Yes No Unknown well? (excepc for schools) Yes No Unknown other? Yes No Unknown Is [here an approved ven[ present? Yes No Is the ven[ func[ional? Yes No I Is chere water presen[ in [he ven[? Yez No `� H of inches Was a soil boring conducted 3' below exis[ing rystem? Yes No Unknown Depth co groundwacer? inches Depth to motded soil? inches Is [here existing soil site evaluation available? Yes No r — — Was boring done by a CST (Cettified Soil Tester)? Yes No Unknown Is owner aware of any backups, surface seepage or discharge, odors, siow drainage, ea.? Yes No If yes explain I certify �hac [he above inFormation is [rue and correcc to �he bes[ of my knowledge as observed on , 19 Opera[ional aspects and observa[ions repor[ed are based on [he conditions noted a[ [he time of inspec[ion. This inspection does not in any way guaran[ee or warran[ee the con[inued operation of the rystem described herein. �J�u � �.� � ��in��y S�1�i0 /�/6 Inspec[or's Signamre / Gede al Number �e Attachments required: # �, �S , ,�,�,x�-� ❑ A � ., �� j ..y,. � ' pproved plans ❑ Soil test report ❑ Copy of maintenance records (if availabte) ',i(�� •� .1� �L� .. r r:r. ' :i ❑ 8"x10" plot plan of house, well, tank(s) and soil absorption system ' �; �.. ,.;.;;�,r-,-�_ • 030-737—OB 2701 e.�anc. 030-737-0 �0 ��,�:. 030-737-08 2101 23.37AC. NW-NW NE-NW � ..}: . 030-737-08 2101 ,, ' y„ ke .,��, 32.StAC. i i - '�, �,� .�. ��,..� 'I',..., �� eFq ��R j C��`� 030-73: 030-737—OB 2101 `� 7' 14.21�C. SW-NW SE-NW 030-737-08 2407 38.a8AC. 030-737-08 T301 39.53AC. 030-737-08 3201 � 36.45AC. �` � �� i0 �� &y� <_ NW-SW � NE-SW �� v Q 030-737—OB 3101 �� }8.54AC. 030-737-08 3202 3.00AC. 030-737-08 3304 p3p_737—OB 3�01 \\ e.o��c. 030- 24.34AC. `\\ \`\ � \\ 030-737-08 33U1 � 28.91AC. o 1 \� en�f 1 ♦ o �� SW-SW SE-SW 8.5 �. 030-737—OB 3402 � �.75AC. O � 1��N �,�, ' o�� O� '� �� O� v� ��.� `�.�� 2.o��c. � � .76AC.� - - =_ __ � I � _.._ 1 �H�WAR� RD� I SHOWN AS 68' WID1H FOR I I I MAPPI►!C PURPOSES.