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Home My WebLink About002-940-26-4304-LUP-2001-356 � Application for Land Use Permit r y � o � � County of Sawyer PO Box 676 -Hayward WI 54843 � 715/634-8288 � r The 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 � r and the laws and regulations of the State of Wiswnsin.CONSTRUCTION b1AY NOT �. , BEGIN UNTIL THE PER1�fIT IS ISSUED. 2 PRINT—USE BLACK INK OR PENCIL � a � 1 6 � j� Cc�^'y ✓�:'I.tky�� kc.�� ,�k« y wRfJ Owner� Builder � o I�c 2 2 td. Co_ �'.o�_ h � � Mailing Address Mailing Address NA y w�� a,J S4��S � � � City,State,Zip City,State,Zip ��J, `F 'i Z. ,vkr'��+.�,��}� `' i Daytime Phone Daytime Phone x � Building Land Use f� S O New O Filling Zone District �1`— � (�j'Addition ( )Dredging ( )Alteration ( )Grading Lot Size o ( )Moving On ( ) _ ( ) ( ) Acres /,.3oZ � A � Pn ary Structure Accessory Building Addition � (�Dwelling ( )Garage-attached/detached ( )Deck � o (,�Year round ( )#of car stalls ( )Porch '�" � ( )Seasonal ( )Storage Building ( )Enclosed s O Frame built on site O Screenhouse O Living room p ( )Modular/manufactured ( )Greenhouse ( )Kitchen �� ( )Mobile/manufactured ( )Other ( )Bedroom N �� - ( )Other primary structure ( ) ( )Relocate/enlarge � ( ) ( ) ( )#ofnew r � Type of Construction � �'= (vYFrame ( )Lo� ( )Pole/metal ( )Block ( )Concrete � ( )Other '� r-. � Construction Cost$ �Z i U�`� � � X 84-iY� .. Vol 7 u�t. Pg Z�� of Deed Certified Soil Test# ��' 2�Z c Y-/�P.�. c. CSM Vol � Pg /� 1 $�/�S S Sanitary Permit# � 1- r q� 8`/'�3G � z Plat Emelope Or. L u P �``1 '�17 I� Condo Vol Pg Year Installed ` Aff of ex septic V P Owner When Installed: � 7 I s��IO� � Q�S-�a� �/l �"lco Application for Land Use Pernut — Page 2 Describe Construction: List dimensions of each structure, story, addition, or alteration. #1. #2. #3. #4. Size z b ft. wide ft. wide ft. wide R. wide � z ft. long ft. long ft. ]ong R. long Floor area '1 �� sq. ft. sq. ft. sq. ft. sq. ft. Hgt.&om gade I o � fi to peak ft. hgt. ft. hgt. ft. hgt. Stories I stories stories stories # ofbedrooms l � y�.�, � - �a. j � y��i+�r reaz lot line or waterline of lake/river In the box sketch in: � Location and size of all �-�� "� s �"`"� �� existing and proposed structures. �� "� s��" � laud ��y ffot.� � Lo( 1 ,ti� Location of septic system. e � �,., ! ;h - - - � cd - ai,✓" k "-� ' Indicate distance to: "' �sz` Waterline/Wetlands � go � �l e c � r I Road ��"V°s� r(v-�s� --� Lot lines a�'}`b� Septic system/privy �- � � i Well rr- -"�,,. ` '� _ � �w �o CL , � 75 ' \� Distance between structures. � �� ; r O ` � Indicate North. � � �� j ��'� � ✓ � .� �4 N C i Fire Number: a'�� - � w� � 5 �? Z li' � , � �, ; � »' � bm,:w)• a . i 1) - � I� rs�N j- �v r " � ' [auw��"` � � re� L �rkN I Signature of Owner The above certifies that the listed I �' information and intentions are true and ' I _ : -- conect.Theaboveperson/s/hereby Cc. K�i. k --�-�-"--- �� give peratission for access to the proper[y for onsite inspection. ------- centei lne of ioad------- Issue Date August 6. 2001 Expire Date August 6, 2002 Office Comments: �/�,��'_ ' � _��'��"" ! Signature of Zoning Administrator wisconsin Department of Commerce SOI� EVALUATION REPORT Page�_of� Division of Safety and Buildings � in accordance with Comm 85,Wis. Adm. Code Counry Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must S 4w t include, but not limited to:vertical and horizontal reference point(BM),direclion and Parcel I.D. percent slope,scale or dimensions,north arrow,and loration and distance to nearest road. P/ease print all information. Reviewed by oa[e Personal infortnation you provide may be used for secondary purposes(Privacy Law.s.15.04(1)(m))- -/�?O• C � Property Owner Property Location CJ' (�-�4-� �'G��b��t `ov1 Govt Lot �y bc' 9/4 �lj 1/4 S Z�i T '�(�' N R y E(or�W Property Ow rs Mailing Addres�ps Lot# Block# Subd.Name or CSM# � �-� � z ,.v_ L U . f�� '`. "� � �j f�� City State Zip Code Phone Number �City �Village [V]'Town Nearest Road i-%., yi �rol' 4�J 7 `?'�� a,5 � � $Y-�7`��T ��7y"� l.etic � l�i i /`�wh��'�,..� � New ConsWction Use:❑ Residential/Number of bedrooms Code derived design flow rate GPD �Replacement ❑ Public or commercial-Describe: Parent material � �� "�" > �� Flood Plain elevation if applidble �✓/� ft. General commenis andrecommendations: 4�DOtahS So.�� S O.�L j ,23 � -�t'� �e(ow s�S'fe� — O � I � � Bonng# L'� Boring I � p�� Ground surface elev. �� • �' � ft. Depth to limiting factor in. Soil Application Rate Horizon Depth DominaM Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft� in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 'E1fSt2 � :�-rz �c � �; A' '� � 3 ..j ,.; Y�',�, r }, � �� :t 12 "ZL ir> �n y�y — 5�- l% � . � ��, �- is 3 2z • ��t 7_� 7�r; w�� — �� s `t. �� ' �' 'i � _r� �i ` �� y cr-�7 -�-siK �L — t�� s � .i/ wK5 �..� < } ��r .a . �� r .,a� fKvvt <<rciw� M�+rY��=r � ; � t H ��[ ( v -�r ��.;.. .�1 � c.c' hQ...� ✓a �,o�,t f'�✓i. �� 2 c�rj.�'�r.�� c1 J"'v Lf�h c� ti 5� ��t �.q + 't ❑ Boring# ❑ Boring . � pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Domina�t Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft� in. Munsell Qu.Sz. ConL Cobr Gc Sz. Sh. 'EN#1 "Eff#2 F i 1 �„}�v.�- � N� ..�U U� j �i �� •� . �.t !GD o ' , , r.� Rx <, �� D r= ve ✓�a - `'i7.bE �V r� j 2 n y o I o.� � vn.�e - '1 4�Y 9 � _.... � j� �� ; ,� , - yP � i e,_. � �.� 7 S' � u,� �; �-�, cr �� vl 7i , 'Effluent#'I =BODs>30<220 mg/L and TSS>30<750 mg/L 'Effluent#2=BODs<30 mg/L and TSS <30 mg/L CS7 Name(Please Pnnt) Si nature CST Number �.r.L(.' ,: �ntq 5' �n `�J:L f qG�a. I V N : �L � � -;� Address �� Date Ev.a�luation Conducted Telephonz Number I 'IC�j W- i,i' li�j' E/ 1'�.� wn,st� Y-'� 7 'r !Y"f 7 - --f!"�I ��it�� S �f . � `� �:��( 3B0.8330(R07/GO) Property Ovmer Parcel ID# Page _of ❑ Boring# ❑ Boring � ❑ Pit Ground surface elev. ft. Depth to limitinq factor in. Soil Application Rate Horizon Depth Dominant Cobr Redox Description Texture SWcNre Consistence Boundary Roots GPD/ft� � in. Munsell Qu.Sz. ConL Cobr Gr.Sz.Sh. 'Eff#1 `Eff#2 ❑ Boring# ❑ Boring � pi� Ground surface elev. ft. Depth to limiting factor in. �il Application Rate Horizon Depth Dominant Color Redox Descrip6on Texture Stnicture Consistence Boundary Roots GPD/ft� ia Munsell Qu.Sz. Cont Color Gr.Sz.Sh. 'Eff#'i 'Eff#2 ❑ Boring# ❑ Boring ❑ Pit Ground surface elev. R. DepN to IimiGng factor in. Soil Application Rate Horizon Deplh Dominant Color Redox Descriplion Texture SWcture Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont Color Gc Sz.Sh. 'Eff#1 'Efftk2 'Effluent#1 =BODs>30<220 mg/L and TSS>30<150 mg/L `Effluent#2=BODS<30 mg/L and TSS<30 mg/L The Department of Commerce is an equal opportunity se�vice provider and employer. If you need assistance to access services or need material in an altemate format,please contact the department at 608-266-3151 or T"tY 608-264-8777. SBD8930(R.0]I00) stories stories P L ` � z v _ stories rear lot line or waterline of lake/river � C= �; u � S � �� c� a 3r� � es. (J- � ti � s�t�K �. �.�i N.� ; N � i � �1 � � � y ��« - - — - - � - � r` : K� � � - - - I � Q1! ' `�� :•r�� I �z I �or �J � Cc ,� u�p � � y �5 I tzJN �; l�v�`�'` '—'� cL� °� � - — � � ` \ ' � � r�— � i�.x.+- �� ' _ � j cu� �► � � L i ; 75 ' . , - I i " `�' � , ; � o �, � � . �. ��e ��: i ° ' / � l , � e , . wc �� / - — � ; 5� ,1� l� /�� ; I y�� X�� • � � � ' i , I� ��- � � ' � j. ; �y - � � � / t.�� / �' r� �A�lctn'� ; ; � GL Ar r c, � i I ! . l �-�0� U(� I ' I r� K� . u ------- center ine of road------- i�'.� • AFf IDAVIT 2�2819 EXISTING SEPTIC SYSTEM Regis�er s Gf6ce SS ONE AND TWO FAMILY SawyerCounry � � Document Number FfFjS�@@@ cervad tor record this_ �I day o+ � ' �A D 20�_at 10_pp o'clocV: M and recorded as vol. —I S L_ IF THE EXISTING SOIL A6SORPTION AREA DOES MEET THE �.g ecortlsonpege q g-99 MINIMUM REQUtREM6NTS FOR GROUND WATER AND BEDROCK (�,; . n _ 7 _ t��— DEPTHS AND IF IT IS FUNCTIONING, AN ADDlT10N TO OR qeg�s�e� REPLACEMENT OF A HABITABLE STRUCTURE CAN BE MADE iN Devur� MOST INSTANCES WITHOUT UPDATINC THE SOIL ABSORPT[ON AREA. IF THE [XISTING SOtL AQSORPT[ON AREA IS UTILIZED FOR THE ADDITION, EVERY ATTEMPT SHOULD BE MADE TO LOCATE AND RESERVE AN AREA WHICH IS SUITABLE FOR A CODE COMPLYINC REPLACEMENT AREA FOR WHEN THE SYSTGM FAILS. ` IF THE ADDITION WtLL SUBSTANTIALLY INCREASE THE iaoo WASTEWATER DISCHARGE, THE EXISTING SYSTEM WILL BE REPLACED W[TH A CODE COMPLYING PRIVATE SEWAGE DISPOSAL SYS'TEM. RETURN TO: Sawyer County Zoning Administration 002-940-26-4301 P. O. Boz 668 Parcel Identification Number Ha ward WI 54843 Owner(s): Gary Johnson Mailing Address: 1SO22 W COUIIty Ro2d R Hayward, WI 54843 Properry description: See AttaChed �� We� Gary Johnson plan io (� Add 1 bedrooms on to an eaisting dwelling; O Add bedrooms on ro an ezisting mobile home O Replace an ezisting dwelling with a new dwelling/mobile home containing _bedrooms O Replacc an ezisting mobile home with a new dwelling/mobile home containing bedrooms The present private sewage has been working satis(actorily as (ar as disposing of wastes. If the present private sewage system does (ail, it will be replaced with one that is code complying. 9j �� /�,�,,.�. � " � ( D�ie Dare I have inspected the existing privatc sewage system tank(s) and I have determined that it/they meel the requirements o(ILHR 83.055 (3) (g) "Deiermination on tanks" (i.e., leakage, condition of baCflcs, tank cover, and tank capacity). 1 have also determined that the capacity o(�he existing tank(s) is gallons and is/are sized for a bedroom dwelling per current (LHR 83 reyuirements. Master Plumber, Mnster Plumber Restric�ed Sewer, Scptage Pumper License Number Date Personally came before me this ��.�n,n„ t ��^�UC�''�. day o( � + l�: •. i N�T � ,� ,. � ��,er * Notaty.Public� 7kF � s • PUE3�.1Cr ' : °�i�...W;;:w�s� ; h o�,,,,•• My Commission expires _ � �'� D � h � w��`�� Ezisting septic system - Sanitary Permit Dare system installed 7.A or AZA date This instniment was drafted by: Gary Johnson V0► 7 � 6PG9g ' r , ,�. ...., .�. ..:; . . .-..n...:a..+a<�....�#.�:...r.�..�-s�7�iaji+.eie.MilrNVtia�.:��-amV.,.. ....:n_aa:a.�::.-- � Lot Four (4) of Certified Survey Map No. 1635 as recorded in the of6ce of the Register of Deeds for Sawyec County, Wiscoasin on April 8, 1981, in Volume S of Certified Sucvey Maps, on page(s) 1171208bei Dac arteof Govecnment Lot � corrected by Correcuon Affidavit in Volume 8 of Certified Survey Maps, on page(s) 08 P , Siz (6) and the Southwest Quarter (SW'k) of the Southeasl Quacter (SE'k); all in Section Twenty-six (26), Township FoRy (40) North, RanSe Nine (9) West, Town of Bass Lake, Sawyer County, Wiscons�n; EXCEPTING the North 180 feet thereof. VOL 7 5 6 PG 9 9 ' � OBSERVATION . ISLAPD IRCH �SIAND GRINDSTONE �4.4 LAKE �4.2 �4.6 •4.5 �4.3 �6.3 �6.5 62 �6.4 6.6 E � � / �� FZHI H 13 14 �6.9 I i.3 2 •6.�� 4 '6.a �6.7 ''4 �6. 1 �6.1 °6.11 �5.1 �6.1 �6.13 i ii � .15.2 .15.3 �Z �7. I iz Iz 15. 15.1 ,O IW I 2 3 i3 15.7 p 12.3 a �7.3 , iSA� � � �72 LE: I INCH=400 FEET FOR RSSESSMENT USE ONLY N8T WN BY: DATE: INTENDED TO SHOW CONCLUSIVE ON (:1 INDIGA7ES GOVT. LOT EVIDENCE OF OWNERSHIP OR BOUNDARY LOCATIONS � � '" r � �� I �� \� , � � : � � � � � �. � � �