HomeMy WebLinkAbout008-938-34-5120-SEP-2002-007 Sawyer County Zoning Administration
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Inspection Report F
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Property Address/Fire # a
Inspection ( ) Dwelling ( ) Setback - lake
( ) Mble Hm ( ) Setback - road
( ) Private ( ) Public ( ) Commercial ( ) Setback - lot line
( ) Garage ( ) Soils Verif r,
Violation ( ) Addition ( ) o 0
( ) ., �
( ) Zoning ( ) Sanitation �'
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Date �'1-'��— pZ Time �:IS —2;�0 r
Signature of Inspector T�`'T}�. �' �-'�4q�� � �
1t��iIS
Office of Sawyer County Zoning Administration
P. O. Box 676
Hayward, Wisconsin 54843
(715) 634-8288
IJRL: sawyercountygov.org
E-mail: scgzone(awin.briglit.net
Fax (715) 638-3277
O1 October 2002
Scott Schiefelbein
2847N East Shore Drive
Birchwood, WI 54817
RE: "Order for Conection", Combination septic/pump tank encroaches 5 feet onto
neighbors Lot to South. LUP 97-276, Sanitary Permit#97-169, 00-206 - 2847N East
Shore Drive—Tax ID # 008-938-34-5120.
Dear Mr. Schiefelbein:
I was asked to inspect a septic setback violation on your property. On Thursday
September 26, 2002, William Christman, Zoning Administrator, Dave Reider, Surveyor
anc� I inspected a possible setback violation.
Mr. Reider had set flags demarking your Lot 5 south property between Lots 4 and Lot 5.
It is very clear to us that the concrete septic/pump tank encroaches onto Lot 4
approximately 5 feet. Code complying setback is 2 feet onto your Lot and 5 feet from a
building. It also appeazs that you have removed or placed the pump electric control box
into the concrete riser.
According to your Land Use Permit#97-276, you noted a sideyazd setback of 20 feet to
the South lot line. We measured 11 feet 6 inches. It appears that you thought your lot
line was 20 feet—25 feet south of the building. I do not think the plumber Kurt Brown
(San 97-169), set the tank in error, if you informed him that your property line was 20
feet +to the South. These enors unfortunately have caused you some major hardships.
Due to the code violation I will set forth the following stipulations.
1. Move the concrete septic/pump tank onto your property (at least 2 feet setback)
within 60 days or no later than November 1, 2002.
2. Have a licensed plumber install the electrical control box onto the riser per code.
A very clear sewer setback violation exists, I am asking for your cooperation. Should
you disregard this notice, I will have no choice other than issue a citation for $335.00.
Enclosed please find my inspection report noting three issues. I am addressing issue #1
only, septic/sewer. The 'Loning Administrator will address issues # 2 and #3.
Finally Mr. Schiefelbein, I am very surprised that you being owner of Timberline
Construction do not know or adhere to code complying setbacks.
Again, your cooperation would be appreciated.
Sincerely
Merton Maki
Assistant Sanitarian
MM/gs
CC: Kurt Brown
Ron Friedell
�� ADDITIONAL COMMENTS AND SKETCH
� SANITARY PERMIT NUMBER: �� —' Zb � .
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COURT ORDINANCE
��110LaTiGN DEPOSIT COSTS TOT,aL SE�TIONS
§ i�i.18 ^vnsite Yilaste Dis�osal Systems
" . Unauthorized �nstailaiion/re�air of system
�30Q.00 �158.uC �45� �i; ;.;c�mm 83
- -�11�.:i 8 ':^v �..^1^1Ci'v b�/ii� �,�i Ci@; i0 repair Tal�lf'C SySic�
�500.00 �204.00 �%04.nr �,cmrr; 83
� ��ilu�? tc :;�cviG� p:�mping repc�
�150.OQ :�;23.�0 W27�.��4 �cr�m Q�.^ '�
�� ��:m�i�g ;;olding ;an� �n unauthorizec area
�500.00 �204.00 ��0�.�0 NR Coces
�; Septic s2wer setbacks �A�ded July 2C, 1995'i
Q200.OG �i 35.�0 �33�.00� Comm 83
;,; imorc�er uis�,osai oT domestic wasie ;added May 23, 1996j Comm 83
$300.00 �158.00 �d58.00� �145.20
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'`� Safety and Buildings Divisio'r�
$ANITARY PERMIT APPLICATION 201 W.WashingtonAvenue p
�sconsin P O Box 7302 O�
Department of Commerce In accord with Comm 83.05,ws.Atlm.Code Madison,WI 53707-7302 - �
• Attachcom lete lans(tothecount co CST 97-059
p p y py only)for the system,on paper not less councy
than 8 trz x 11 inches in size. �A4„�
• Seereversesideforinstructionsforcompletingthisapplication s<acesa�aaryrermicNumber
Personal information you provide may be used tor seconda 348478
IPrivacy Law,s.75.04(i)(m)]. q Pufposes ❑Check if revisbn�o prewous appf tion
� State Plan I.D.Number
I. APPLICATION INFORMATION-PLEASE PRiNT ALL INFORMATION
PropertyOwnerName PropertyLocation Vt t
SGo? Sf.FI l E�El.�l r�( �� tia �{�iia,S � T� ,N,R �or)W
Property Owner's Mailing Address Lot Number Bbck Number
n159�y Ge�� Fox Tizai� 5
Cit State Zip Code Phone Number Subdivision Name or CSM Number ('$�/ot, j
�jw_+..��ar,l LJi 53 I c4ia>543-2.�26
II. TYPE F B ILDING: (check one) ❑State Owned � t Nearest Road
Public 1 or 2 Famil Dwellin -No.of bedrooms�_ �olrag oF�DGffu�Ai��. �� ${�pPk p�.
���. BU����N�7 USE: (Ifbuildiogtypeispublic,checkallthatapply) � ParcelTaxNumber(s) � �
1 ❑Apartment/Condo �v-q3�J'34-5f2'V
2 ❑Assembly Hall 6 ❑Medical Facility/Nursing Home 10❑Outdoor Recreational Facility
3 ❑Campground 7 ❑Merchandise:5ales/Repairs 11 ❑ Restaurant/Bar/Dining
4 ❑Church/S<hool 8 ❑MobileHomePark 12 ❑Service5tation/CarWash
5 ❑ Hotel/Motel 9 ❑Office/Fadory 13 ❑Other.spec�fy
IV. TYPE OF PERMIT: (Check onlyone box on line A. Check box on line B,if applicable)
q) �. �New Z_ �Replacement 3_�Replacement of q. �Re<onnection of 5. �Repair of an
______SYstem__ _SYstem __ _TankOnly _ _ _ __ExistingSyztem____ __ Exi ingSystem
rf
8) A Sanitary Permit was previously issued. Permit Number Date Issue �(
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11❑Seepage Bed 21�Mound 30❑Specify Type 41❑Holding Tank
12�Seepage Tren[h: 22❑In-Ground Pressure 42❑Pit Privy
13❑Seepage Pit 43�Vault Privy
14QSystem-In-Fill ���- �IGH �C�'7Y C��"��'�-S
VI. ABSORPTION SYSTEM INFORMATION:
1.Gallons Per Day 2.Absorp:Area 3.Absorp.Area 4.Loading Rate 5.Perc.Rate 6. System Elev. 7. Final Grade
Required(sq.ft.) Proposed(sq.ft.) (Gals/day/sq.ft.) (Min./inch) Elevation
4"� '��(03 318•l0 . c3 �b.`j Feet 95.d Feet
VII. TANK Capaaty
INFORMATION �n gatlons Total #of Manufacturer's Name Prefab. sice Fiber- plastic F•Pe'
New Existin Gallons Tanks Concrete Con- Steel glass a.pp.
Tanks Tanks strucced
Septic Tank or Holding Tank �Qpp �QDO � SKAW COM(3. ❑ ❑ ❑ ❑ ❑
❑ftPumpTank/SfphonChamber �LKiO —� (pbG � � � � � �
Vlil. RESPONSIBILITYSTATEMENT
I,the undersigned,assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber'sName:(Print) Plu 'sSig ture:(N Stamp:) P PRSWNo.: Busine55PhoneNumber:
orJ �e,�p�� Z2656d.. 715 �31-302-C�
Plumber's Address(Street,City,State,Zip Code):
l4 19 13-r"A�l �A��.3 lx7L 4P��z_
IX. COUNTY/DEPARTMENT USE ONLY
❑DiSappfov2d SanitaryPermitFee�1nfi°�'c�oune..aie� ate ssu Is ing ent �gn u Sta ps)
pproved �Owner Given Initial
$170.00 zurhagfe' 6/26
Adverse Determination
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
IMPORTANT NOTICE: Wisconsin State Statute, Chapte 45.245
(3), states you are required to have your septic tan pumped/inspect d
at least once every 3 years.
CRI'1_FtOR(p d1001 DISiR19UT1pN:Origirul�oCounty,On¢�opyTo:Safe�y68uilJings�ivivion,flwner,Plumber
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(No Sc�lh)
. �rr��dved Ldr_king tilanf�ele Cover '
tJith Warning !_ab�l Attached �
We�thpt•hrenf � �P►�roved
Warning Labh1 JunCt�nn �ox � Yent Cap ,,,�
t 1. �i imUn
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r�„�1 Gt-ad�± ��� Min�mum � - -4" f4in9mum
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lf1" Ftinimum , ` r � insp, p�pp � �___ � � biscvnnect
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����t�c hun,p ynd �1�rm Are vn Spr:�rate c 1 rcul ts Numb�r� ef bns�s: �,her bay
Gallens h�r bayj� of Doses: 15U G�llons
VblUttip b� �BCICf�t�W: . . . � s , �+��_Gallons
Y�►�k F1�r�iiraci.�irar: k�� td�Al Ubs� Valump:. . . . � . . :=�_��llor�s
.�_____,-------
i�nk Sizp-Sepi:ic/hum��:— i�,�,�o ��al�ons
111�rm ���nuf��cturer; � , ;5.��
t•t���fe1 Numher: ��� _ C�pac�ti�s: A 22 i nches nr 3�7-. Gal l ons
Sw i tcli 7yl�e:.��n�(zs=,;;2� _ _ � g 2 1 nches dh��_Gal l ons
ri�rn�� Fia►itifact:urpr: Lv�� _ ",�� __ ____ + C �•z. incN�s br_ i�i � _Gallons
F1���1e1 Idumber: �� + b�_inches ot-�,�Galloris
��� tntal , � . � .- inches br Gallons
��linimum piscl�ar-ge tT:. �,� _3�_ _�--
vert,ic�1 hif�pl-�ncp bptwp�n r�mr o�� �nd bistr�but�nn p�pp: 2� ��pt
Mitiirnum nec�uit-ed Siir�,ly hressure: . . . . . . . . . . < < . . � . . � • • • • � • •+----Y���
�r�p ree1; (t� r01'Cp M�in x .7 d� rrict�dn �aCtar/1nU ���t: + .i�1"�et : �:; `: . � .. .
`_��'_Inch t�i�meter 1'e�t-ce hta�n � � ,
t�ta1 byn�imic Npad:. : == �U,iz.�eet
lrit.rrn�l 1�nk 1)imensinr�s: Lenyth_(��__; W1dth ,��i L1qu�d bepth 3�
;icr�7l.ur�e I��,_,. , Llcpnse N�nnber 2,'�(�J�-0ate J J� _�'O
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' ,� � PRIVATE ONSITE WASTE TREATMENT SYSTEMS counry
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CO/'ISl/� ( POWTS)
Department of Commerce INSPECTION REPORT C
Safety and Buildings Division J��u "e►�—
(ATTACH TO PERMIT)
Sanitary Permit No:
GENERAL INFORMATION
Personal information you provide may be used for secondary purposes[Privacy Law,s. 15.04(1 xm)] �C� —2--0 V�
Permit Holder's Name:
1' I ❑City p Village C�cfown of: State Plan Transac6on ID#:
SccTT SC ��e e � Oe �'h -}.
CST BM Elev: Insp BM Elev: �� 'e`'Ja `�~`
BM Description:
Parcel Tax No:
t��' 110.. O vt �2.�� �t r�
TANK INFORMATION O°� -9�-3Y-S� O
TYPE MANUFACTURER ELEVATION DATA
CAPACITY STATION BS HI FS ELEV
Septic C►o� ►pp d Benchmark
w
Dosing ,� t 6�
Aeration
Bldg. Sewer
Holding St/Ht Inlet
TANK SETBACK INFORMATION ��•
St/Ht Outlet
TANK TO P/L WELL BLDG RNNTAKE ROAD
Dt Inlet
Septic +i U +ZS -���, �S NA Dt Bottom
Dosing �� �� ,� �� NA Installation �v4�33
Aeration Contour
NA Header/Man.
Holding q 3
Dist.Pipe
PUMP/SIPHON INFORMATIOfV Infiltrative
Manufacturer Surface 9 ��
c� y.. Demand Final Grade
Model Number
�b � 3 S GpM
TDH�,S--Lift Fric6on Loss s,iZ System Head— TDH�,,Ft �
, Forcemain Length Dia z' Dist.To Well .� *c;�.� _
DISPERSAL CELL INFORMATION
DIMENSIONS Width 3� Length 31� No of Cells
S 3 Type of System Manufacturer:
SETBACK oHWM of Nav LEACHING
INFORMATION P�� B�d9 wel� waters CHAMBER
C�t4wb4� Model Number:
CELL TO s +ZSO �-ZOU fi 3 pp c�--
DISTRIBUTION SYSTEM ` ��`�`�'��� t-
Header/Manifold X Pressure Systems Only
Distribution Pipe(s) X Hole Size X Hole
Length Dia Length Dia Spac Observation Pipes
SOIL COVER Spacing ❑Yes ❑No
Depth Over Depth Over De th of
Cell Center Cell Ed es p Seeded/Sodded Mulched
To soil ❑Yes ❑No ❑Yes ❑No
COMMENTS: (fnclude code discrepancies,persons present,etc.)
F`�'�'e �' �8 41 C o�, � o -��,��c � - ,
i �- ,., 9� — S�� 91 -i 6`1
Plan revision required?C]Yes�1 No 6 Z��l
Use other side for additional information Date J � � Z r � 0
POWT Inspector's Signature Cert No
Bureau of Field Operations,PO Box 7302,Madison,WI 53701-7302
SBD-6710(R.3/01)
I
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SafetyandeuildingsPivision �
�::..�.�. SANITARYPERMITAPPLICATION BureauofBuildinqWaterSyste�
In accord with ILHR 83.05,Wis.Adm.Code 201 E.Washington Ave. �
P.O.Box 7969
CST 97-059 Madison,W153707-7969
• Attach<omplete plans(to the county copy only)for the system,on paper not lers councy
than 8 vz x 11 inches in size. �
• Seereversesideforinstructionsforcompletingthisapplication scacesan�ca�yPe�mrtNumbe�
284936
The information you provide may be used by o[her government agency programs ❑Check il rc n io previous applica�ion
IPrivacyLaw,s.1504(1)(m)�_ . StatePlanI.DSNumber
I. APPLICATION INFORMATION-PLEASE PRINT ALL INFORMATION
Property Owner Name Property Location
•-aa ( tfo,5 T ,N,R E(or)�
PropertyOwner'sMailingAddrers LotNumber BbckNumber �
City,State ZipCode Ph�neNumber SubdrvisionNameorCSMNumber CS Vol 18 Pg 51-52
� � )
II. TYPE O BUILDING: (check one) ❑State Owned ❑c'ty Nea�est Road
❑Village
❑ Public 1 or 2 Famil Dwellin -No.of bedroomz �_ rown oF S
III. BU��.��N�7 USE: (Ifbuildingtypelzpubllc,checkailthatapply) �� . ParcelTaxNumber(s) .
008-938-34-5120
1 ❑Apartment/Condo
2 ❑Assembly Hall 6 ❑ Medical Facility/Nurzing Home 10❑ Outdoor Recreational Facility
3 ❑Campground 7 ❑ Merchandise:Sales/Repairs it ❑ Restaurant/Bar/Dining
4 ❑Church/School 8 ❑ Mobile Home Park 12 ❑Servi<e Station/Car Wash
5 � Hotel/Motel 9 ❑Office/Factory 13 ❑Other:spedty
IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line e,if appli<able)
q) �_ �New z_ �Replacement 3, �Replacement of � q_ �Reconnection of 5 �Repair of an
System System Tank Only Existing System Existing System
-----------------------------------------------------------------------------
B) ❑A Sanitary Permit was previously issued. Permit Number Date Issued
V. TYPE OF SYSTEM: (Che<k only one)
•Non-Pressurized Dislribution Pressurized D(s[ribution Experimental O[her
17�Seepage Bed 21❑Mound 30❑Specify Type 41❑Holding Tank
12�Seepage Trench 22❑In-Ground Pressure 42❑Pit Privy
13❑Seepage Pit 43❑Vault Privy
14❑Sysiem-In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1.Gallons Per Day 2.Absorp.Area 3.Absorp.Area 4. Loading Rate 5.Perc.Rate 6. System Elev. 7. Final Grade
Required(sq.ft.) Proposed(sq.ft.) (Gals/day/sq-ftJ (Min./inch) Elevation
� q Feet ,p Feet
Ca acit
VII. TANK in gallons Ga�ltons Tanks cor�c ece s�te sceei 9iae5 P�ast�c ApP'
INFORMATION Manufacturer's Name co�-
New Exiztin svucted
Tanks Tanks
SepticTankorHoldingTank QQQ � .OpO � ❑X ❑ ❑ ❑ ❑ ❑
Lift Pump Tank/Siphon Chamber � CAM6•TANK ❑ ❑ ❑ ❑ ❑ ❑
VI11. RESPONSIBILITY STATEMENT
I,ihe undersigned,assume responsibility for installation of the onsite sewage system shown on the attached plans-
Plumber'sName:(Print) Plumb r'sSi nature:(NoStamps) MP PRSWN . BuslnessPhoneNumber.
Plum ber's Address(Street,Gty,StaTe,ZIp Code):
IX. COUNTY/DEPARTMENT USE ONLY
❑Di58pproveCl SanitaryPermitFee�'"a�de,c�o��dwaie� Datelssue Issu� g gentSignature(No5 mps)
s�,�ha,9e���, 7�14/ / /(
Approved �Owner Given Initial $170.00
Adverse Determination
X• ��T1J�S���fiP�PEROV�I/REASONS�OR DI�APPROVAL:
isconsin tate tatute, Chapter 145.245
(3), states your are required to have your septic tank p�ped/inspected
at least once every 3 years.
. q
� � ,. �#
i
PLOT PLAN SYSTEM EL. = 90.9' (PER SOIL TES'1� �
SCOTT SCHIEFELBEIN SLOPE WILL NEED TO BE CUT IN ORDER
N5989 GREY FOX TRAIL TO MEET DEPTH REQUIREMENTS
SiJLLIVAN, WI 53178
SIGNED:
414 593 2626 MPRS#3352
DAILY FLOW = 450 GALLONS
ABSORPTION AREA REQUIRED = 643 SQ. FT.
A 14' X 46' BED IS PROPOSED
EAST SHORE DRIVE
N
1JoT uRAwN TO 5C�►�
388'
30'
DR. WAY
L� 103' 110'
CHETAC 92.6' S 95.4'
120'
HOUSE 14' X 46'
BED
250' - 3" FORCE MAIN
25' 94.3'
1,600 GAL. COMB. TANK 5� 95.3'
BM
388' PUMP EL. = APPROXIMATELY 65.1'
NO WELL OR UTILTI'IES ARE LOCATED �
ON PROPERTY AS OF 7 - 5 - 9'7
BM = 100.0',NAIL IN WHITE BIRCH TREE �
�
�
�1
� -- �
SEPTIC TANK � _PUMP CH/1MBER �CROSS SECTION AND SY:_`�.= ..���Z IONS . .
� . l
4" CI VENT PIPE 12" MIN . ABOVE GRADE � �UNCTIONPBO�X�. APPROVED
>_ 25 ' FROM DOOR ; WINDOW OR � WITH CONDUI`I'r, � MAN::OL� �OV�R
FRESH AIR INTA�CE . W/ PA��OC'� �
4" CI RTSER ' �----G�A�'�1ING ?�1��r
FINISHED GRADE 6 +� MIN . ' �
�^ ���4 " M I?�' .
�., ABOVE G ADE
lg�' IN . g�� MAX . \`1 ,, .
• ` � �
� �
INLET � ` �
� L '
GA�S- � � � /
'\WATER TIGHT SEALS � TIGHT � �� ��
p �. SEAL � � APPROVEP
4
�� BAFFLE _}� � � ALM �OIN`I'S 4J/ CI
CI PIPE B ' ' ' ON PIPE 3 ' OI�1"'0
3 ' ONTO � : i �� SOLID SOIL
SOLID � � � � � ,.:; RISER rXTT
SOI L pUMP OFF ELEV . �-9'�. �'T• � OFF ' �
PERMITTED O�LY
D ' IF TANK
• � MANUFACTURE� .
HAS APPF.OVA� �
3�� ppPROVED BEDDING UNDER TANK CONCRETE PAD
SPECIFICATIONS
SEPTIC / DOSE NUMBER DOSES PER DAY : 3 '
TANK MANUFACTURER: cKAw PRECl�SL . D�,,,y,�K= 2��_3�� p=Pcx ,8f.g GA�/FT� qzGA�.
TANK S__� SEPTIC i,� �AL. DOSE VOLUME FLOW'BAEKG 2y____�____ GAL .
DOSE ���_ G
t�SE YOLadNE+ '�l�PT3= is�_ INCHES = �_GAL.
ALARM MANUFACTURER: ��RO ��'SIEMS
CAPACITIES : A
MODEL NUMBER: 101 H1�1 - g = . �2 INC HES = �_�AL .
SW I TC H TY P E: !AE �—�---- •
� _ �. INCHES = �.p GAL.
PUMP MANUFACTURER : �nF i �ER - ,
MODEL NUMBER : ��� •• D = �_ INCHES = yq,yl GAL .
SWITCH TYPE: ��r�^,�QY .
REQUIRED DI SCHARGE RATE -r�b GPM PUMP � ALARM WIRING AS PER I LHR 16 . 2 3 WAC
FEET
VERTICAL DIFFERENCE BETWEEN P�UREOFF .AND •DISTRIBUTION PIPE . • ; --�� FEET
+ MINIMUM NETWORK SUPPLY PRESS — FEET
+ �-� FEET FORCEMAIN X J�FT/100 'FT.OTALIDYNAMICAHEAD • _ � FEET
INTERNAL DIMENSIONS OF PUMP TANK: LENGTH �_�
WIDTH �; DIAMETER NR •
• LIQUID DEPTH 3q • ►b•y'� �P=
� �
SIGNED:
LICENSE �1UMBER : Mp� �35�__ DAi E: 7/6[4'] _
Application for Land Use Permit � �
County of Sawyer o', .,
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 and the laws and regulations of the State of Wisconsin. ��
, (' � PRINT-USE BLACK INK OR PENCIL ".
�(,O�T SC�le1�2Ib�1 Y} ✓ 5r_�� �S��r����� I�C.��/1 IT�Rt�rI�NCC> �° �
Owner Builder �
� � ��� Grcti9 �ax �r'. /V��T��I Gr�7 �ox�r. ��
Mailing Address Mai ing Address 1
>�����'�G�'! l.�l� �.�1�� Sv�l�'�a✓� Wl �J31�� �
iC,ty�tate,Zip City,State,Zip �
�//�l- 5�3- 5� 7�d yl�Y�553-57��
Daytime Phone Daytime P one o O
Building Land Use Zone District �� � �..- � �
(p�New ( )Filling
( )Addition ( )Dredging /. r�Q
( )Alteration ( )Grading Lot Size �
( j Moving On � � Acres @ /� �'�C� � �
�
New Construction �Ithqc�Cd �ara�C p��k >
C'
Size 'z/�+ ft wide �'wide ��'wide �
m
�$� ft.long �'long ���'long �
�
Floor area /(�GO sq ft �_sq ft ,'�.(�D sq ft ay r
� �J
'Total hgt /�� to peak �_�'hgt l7'`d� 'hgt
Stories 1
No.of Bedrooms 3 �,�� 9 rear lot line or waterline �
� i �P�-- �03�'�� v, T
ear roun or(seasonal) � � I c r
� o
Type of Bidg,Addition,Use ,�p` �G� �' .Q
(x�Dwelling , �� .�
(,�j Garage(� (2)car 2o'r� �-- 35 �
( )Storage Building
( )Boathouse `' QP�� ^�
( )Livingroom z� ' I
( )Bedroom � ��
( )Kitchen-Dining , J� 6� -b
( )Porch(enclosed) (roofed) �n �.a' _ _ o
(,,�Deck-open v� � �
( ) m �° G� � � �
1 2$' ! � I
Type of Construction w � o
(�Frame (�Block '
( )Log ( )Concrete "' �
( )Pole ( )Steel
( ) ( )Pole/Metal �y�' (��%
Construction Cost$ �/(1hQOD,t7t� �!
Vol .i�n� Pg�3� _of Deed �..3
CS Vol� Pg 5 6 r �. �
., � �
Cer.Soil Test Q'I--pS� r,- ' n'S( � � ° w
---33�--------C road--------------- 9—P 'z
Sanitary Permit �'j�- i(r�Fi ✓ � L � �
��� ,�, �jr�,r r= �,�r,� P�D 7 �6'.,✓ Fire No. z
c��
7y
Issued ,\.� 1 � lq°"� Denied _ ot� �
w
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Owner Zoning Administrator �
t ,/� �� p
�,/07�� A ��"`per- MR.y b� tlS�� Qur,�S C.ons/!'c/Gf,o✓t— �5�r_1��v�"
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