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HomeMy WebLinkAbout010-941-25-2223-SAN-1978-149 \ . ��� �P L B 6 7 � State and County State Permit # 18907 __ � Permit Application County Permit # _8_'�149_ _ for Private Domestic Sewage Systems County Sawyer _ CST 8-245 - "DENOTES STATE APPROVAL REQUIRED ��� - 941- 25-�o- Date Approval Received from State if Required State Plan I.D. # �� � 3 __ _ /Q`7�7/�) �eC �rh� LH A. OWNER OF PROPERTY ; .- _, �- �:,ii Maiting Address: . � ��y�) r �-- 13� � 1 S_ �� B. OCA N: Y4 ///U '/d, Section ��_, T L� N, R_ J� j�-�- �(or) W Lot#/ � City_ Subdivision Name, nearest road, lake or landmark Blk# Village Town sh i pi�b������'ff,�f�� �-� C. TYPE OF OCCUPANCY: Commercial *Industrial *Other (specify) *Variance Single family �__ Duplex No. of Bedrooms "'� No. of Persons .� D. TYPE OF APPLIANCES: Dishwasher --��5 �NO Food Waste Grinder �6� � N # of Bathrooms_— Automatic Washer 1� YES �6-, Other (speci ) _ E. SEPTIC TANK CAPACITY Total gallons No. of tanks � "Holding tank capacity Total gallons No. of tanks New Installation Addition Replacement_ Prefab Concrete *Poured in Piace Steel Other (specify) __ F. EFF�T DISPOSAL SYSTEM: Perc ation Rate 1) � 2) 3) Total Absorb Area sq. ft. New Addition Replacement *Fill System Seepage Trench: No. Lin. Feet Width Depth Tile Depth No. of Trenches____ Seepage Bed: Length��Width��_Depth �__Tile Depth�_No. of Lines �_ Seepage Pit: Inside diameter Liquid Depth_ Tile Size � Percent slope of land Distance from critical slope _ / • I, the undersigned, do here certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I tiave sized the effluent disposal system from the EH-115 prepared by the Ce 'fi d Soil Tester, NAME — � _C.S.T. # ��7� � and other information obtaine rom � (owner/builder�. Plumber's Si tur � p� # Phone # ������� Plumber's Address PLAN VIEW: Provide sketch below of system (include direction of pe and all distances in accord with H 22 includin well). --- _9. - -- ----��� ��� f /� 4'1 — � � , � �, � � 3 : � � . � � __ � o t ` � � � � ' � .. . ,. .-.... . . -.- -y- ,.�...__{_ y_.. _� 1 � F ( � ' __.._ ,.- .�._. { .� � • / -_— ,, � ..+. >�.__..{, �_._. � -•-•- .. � / � ' � >� �,/ , .-E -- ?- � , . _ �__ \� ' ���- �3� �� _ . ; ,� �,��-�` �e � � ��- r�'� �i � f_ � � � � ' �� w� �� M�f.._+_�,_._. � r . ' � _� _. �� _ ., t-- —�— , � � � _ � _ < � t . � s._ _ � i 1 __i. � _ _. . , . f i � i E ( f _ f _ , j __. --�—_._,_� y_ �_._� ' w �..�.1-- _. .s_.�._:__--:_ � _ �-- , t +—._ _ �.. ��. [ ��.. � i � I i � . , i ;.�_....... �__.a�r —i--__� ..._:�.......... j..._ _.�_...._.r_ i._— .�_...Y._.. _.. �---- -}-'——t--'_ _...T_,........__.�. , __... �3 -.... _� _. 5 a , ; ( , f_�. � � _� _.�... _ �—_._� , � � i i ' � , . � i ; � , � � � . . , . j � , :. - �. i _.. t. _� _�� __. _._ _ __._ �. � �j.. ` _�_�L _ , .,,__ . ,..._ . -r--- , >_.._. w___.. ��.... . . . _ � �_..... .. I� �._ - , � ! • ' . , � ! � " � i � � Do Not Write in Space Below - FOR DEPARTMENT USE ONLYS Date of Application 9-15-78 Fees Paid: State 10.00County 15.00 Date Ser�tem�er 1978 Permit Issued/ (date) _Issuing Agent Name Ela?ne M Nehrling Inspection Yes No Valid# Date Rec'd 1. county (white py) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON; WI 53701 � state (pink copy) ��;� 4. piumber (canary copy) Revised Date f/1/76 �f C�3>' 7 ' r . Department of Zoning and Sanitation o Sawyer County � m �s Inspection Report � Owner Gary S . Inhoff n K Addres5 p,0. Box 153 Hayward , Wisconsin 54843 �' Name of business a x Builder °, ro Address Plumber LaVern Dennis AddPess Winter Wisconsin 54896 H 0 Inspection � � � Private ( ) Public Property Sanitary-instal °, �� � Dv�elling Setback - lake Violation Mobile Hm Setback - road Garage Setback-lot line y ( ) Sanitary ( ) Zoning Privy 'S� a n r a 0 _ �* - �,` ���� � � � I 8��� � r�� I � I o I 0 x�� � � � cs' C1, CA � N' � 1— '�y 3 6dcm ¢ t� '1S ljBnlc �`' �0 }�o;MQ. � ��� p t� IB � � 440 S}tie.� • , rn Tu,.K u�- d�}� � uscd 4 �;sc�- • y r � in w�xe �.0 .�.... {,L`� o� �}2:� (a�.:e( � � g�.d So.� , a ,�3^I � r Discussed with owner yes no x' Discussed with builder yes no I Jiscussed with plumber yes no �O Disc�zssed with yes no Date - � �{ — �gj 1 Signature of Officer � • �..- TOWN O � HAYWA R C � / ���SECTION '25 , ' TWP 41 N , R �y.91, y.9�• � � / � I 4�� - 6.4 �6.3 � � � q �SG � N � �� � � �� � � �41� Mq� N6a A.�.� • N � 3 .b � , 6�� 4 a •41. � ' A.0.93 A./.SG (V � o •6. 1 � , 6,1y ,� �.4�, < �3 �` � � I . 6.13 ,5 �.�a 5,� • ^ ,L �� ,.�� , i � - - - . ic. i5 - - b.lo , , : N 4 i � ---- - . 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